Fill - Free fillable form of ownership of Taxpayer.: Audit Disclosure Authorization (City of Chandler) PDF form

Audit Disclosure Authorization Form Instructions

PURPOSE OF FORM

Form 285A enables any individual, sole proprietorship, joint

filers, corporation, group of consolidated or combined

corporations, partnership, estate, trust, or other organization,

association, or group thereof (“Taxpayer”) to designate a

person (“Appointee”) to whom the Arizona Department of

Revenue can release confidential information, if the release of

such information is not otherwise authorized by A.R.S. § 42-

2003. The disclosure of such confidential information may be

necessary to fully discuss tax issues with, or respond to tax

questions by, such Appointee.

INSTRUCTIONS

Section 1- Taxpayer Information.

Enter Taxpayer’s name, address, and daytime telephone

number on the lines provided. Taxpayer may attach a

supplemental page to the form if section 1 does not provide

sufficient space for the required information. If Taxpayer is a

consolidated or combined group of corporations, Taxpayer

must attach a federal Form 851 or a supplemental sheet, as

applicable, containing the names of each member of the

consolidated or combined group for which the signator of

Form 285A is a principal corporate officer.

An individual taxpayer, sole proprietorship, or joint filers must

provide a Social Security number(s), Withholding number, or

Transaction Privilege Tax License number, as applicable.

Taxpayers which are corporations, partnerships, or trusts must

provide their Federal Employer Identification number and a

Withholding or Transaction Privilege Tax License number, if

applicable. Taxpayers which are estates must provide either

the decedent’s Social Security number or the estate’s Federal

Employer Identification number, as well as a Withholding or

Transaction Privilege Tax License number, if applicable.

Section 2- Appointee Information.

Enter the name of the person you are appointing to be

authorized to receive Taxpayer’s confidential information. The

Appointee must be an individual. For an Appointee

Identification Number, please provide Appointee’s Social

Security number, CPA number, State Bar number, Alternative

Preparer Tax Identification Number, or any other

identification number including one assigned to Appointee by

Taxpayer.

Section 3- Tax Matters.

You may use this form for more than one tax type. Please

check applicable boxes and specify the tax year(s) or tax

period(s) for which Appointee is authorized to receive

Taxpayer’s confidential information. A general reference to

“all years”, “all periods”, or periods or years “to present” will

be accepted as applying only to tax years (periods) ending

prior to the date this form is signed. A general reference to

“all future” years or periods will be subject to a four year

limitation. Also, check the box that properly describes the

form of ownership of Taxpayer.

Section 4- Revocation of Earlier Authorizations.

This Disclosure Authorization Form does not revoke any

earlier authorizations or Powers of Attorney on file with the

Arizona Department of Revenue. If you want to revoke all

prior authorizations and Powers of Attorney, please check the

box. If you wish to revoke only some prior authorizations

and/or Powers of Attorney, please check the box and list those

authorizations and Powers of Attorney that you wish to remain

in effect.

Section 5- Signature.

HOW TO FILE FORM

Please submit this form to the specific auditor or audit section

of the Department that Taxpayer is currently working with.

Type of Entity Who must sign

Individuals,

Joint Filers,

and Sole

Proprietorships

Corporations

Partnerships

& Limited

Partnerships

Trusts

The individual/sole proprietor must

sign the authorization. If Taxpayers

are a husband and wife (or former

husband and wife), both spouses (or

former spouses) must sign the

authorization form.

A principal corporate officer within

the meaning of A.R.S. § 42-

2003(A)(2) must sign the

authorization.

A partner having authority to act in

the name of the partnership must

sign the authorization.

A Trustee must sign the

authorization.

Limited

Liability

Companies

A member having authority to act in

the name of the company must sign the

authorization.

Governmental

Agencies

An officer having authority to act on

behalf of the governmental agency

must sign the authorization.

ADOR 03-0030

(4/00)

ADOR 10953 (1/11)

1. TAXPAYER INFORMATION: Please print or type. Enter only those that apply:

Taxpayer Name(s) Employer Identification Number

Present Address - number and street, rural route Apartment/Suite No. Arizona Withholding Number

City, Town or Post Office State Zip Code Arizona Transaction Privilege Tax License Number

Daytime Telephone Number (with area code) Social Security Number(s)

2. APPOINTEE INFORMATION 2nd APPOINTEE INFORMATION (if applicable)

Name Name

Address (if different from taxpayer’s address above) Apartment/Suite No. Address (if different from taxpayer’s address above) Apartment/Suite No.

City, Town or Post Office State Zip Code City, Town or Post Office State Zip Code

Daytime Telephone Number (with area code) Daytime Telephone Number (with area code)

Social Security or Other ID No. Type

3. TAX MATTERS: The appointee is authorized to receive and discuss confidential information for the tax matters listed below.

TAX TYPE YEAR(S) OR PERIOD(S) TYPE OF RETURN/OWNERSHIP



Income Tax



Individual Joint Return



Partnership



Individual Single Return



Fiduciary-Trust



Corporation



Fiduciary-Estate



Transaction Privilege

and Use Tax



Individual/Sole Proprietorship



Limited Liability Company



Partnership



Corporation



Limited Liability Partnership



Trust



Estate



Withholding Tax



Other (specify tax type): Specify type of return(s)/ownership:

4. REVOCATION OF EARLIER AUTHORIZATION(S)

Check this box if you wish to revoke any earlier authorizations or Powers of Attorney on file with the Arizona Department of Revenue.

The revocation will be effective as to ALL earlier authorizations and Powers of Attorney (even those relating to a different tax

type) on file with the Department of Revenue except those specified (please specify):

5. SIGNATURE OF OR FOR TAXPAYER

I hereby certify that the Arizona Department of Revenue is authorized to release any and all confidential information concerning the

above-mentioned Taxpayer. By signing this form, I certify that I have the authority, within the meaning of A.R.S. §42-2003(A), to

execute this authorization form on behalf of the above-mentioned corporation(s), limited liability company(ies), trust(s), estate(s),

partnership(s), and/or individual(s). I understand that to knowingly prepare or present a document which is fraudulent or false is a

class 5 felony pursuant to A.R.S. §42-1127(B)(2).

Î ________________________________________________ Î _______________________________________________

SIGNATURE DATE SIGNATURE DATE

________________________________________________ _______________________________________________

PRINT NAME PRINT NAME

________________________________________________ _______________________________________________

TITLE TITLE

Audit Disclosure Authorization Form

ARIZONA DEPARTMENT OF REVENUE

ARIZONA FORM

285A

Effective February 29, 2000

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