Blank Arizona 285 PDF Template Modify Form Now

Blank Arizona 285 PDF Template

The Arizona 285 form is a Disclosure Authorization Form that allows taxpayers to authorize the Arizona Department of Revenue to share their confidential tax information with designated appointees. This form is crucial for individuals who wish to grant access to their tax matters without transferring any powers of representation. It is important to note that the Arizona 285 form does not replace any prior authorizations already on file.

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Overview

The Arizona 285 form, also known as the Disclosure Authorization Form, serves a specific purpose in facilitating the communication of confidential taxpayer information. This form allows taxpayers to designate an appointee who can receive sensitive tax-related information from the Arizona Department of Revenue. It is important to note that the Arizona 285 form does not grant any powers of representation to the appointee, distinguishing it from a power of attorney. The form requires detailed taxpayer information, including names, Social Security numbers or ITINs, and current addresses. Additionally, it provides space for appointee information, allowing for a second appointee if necessary. Tax matters covered by this form can include various tax types such as income tax, transaction privilege tax, and withholding tax, among others. The form also clarifies that it does not revoke any prior authorizations on file, ensuring continuity in the management of taxpayer information. Lastly, a signature section is included, where the taxpayer certifies their authority to execute the form and acknowledges the legal implications of providing false information.

Form Example

ARIZONA FORM

285B

DISCLOSURE AUTHORIZATION FORM

You must sign this form in section 5

This form authorizes the Department to release confidential information of the taxpayer(s) named below to the appointee(s) named below for the tax type(s) specified below. This form is NOT A POWER OF ATTORNEY and DOES NOT grant the appointee(s) any powers of representation.

1. TAXPAYER INFORMATION: Please print or type.

 

 

 

Enter only those that apply:

 

Taxpayer Name

 

 

 

 

 

Social Security Number or ITIN

 

 

 

 

 

 

 

 

Spouse’s Name (if applicable)

 

 

 

 

 

Spouse’s Social Security Number or ITIN

 

 

 

 

 

 

 

Current Address - number and street, rural route

 

 

Apartment/Suite No.

Employer Identification Number

 

 

 

 

 

 

 

 

City, Town or Post Office

State

ZIP Code

 

Daytime Phone (with area code)

AZ Transaction Privilege Tax License No.

 

 

 

 

 

 

 

 

2. APPOINTEE INFORMATION

 

 

 

 

2nd APPOINTEE INFORMATION (if applicable)

 

Name

 

 

 

 

Name

 

 

 

 

 

 

Current Address (if different from taxpayer’s address above)

Apt./Suite

Current Address (if different from taxpayer’s address above)

Apt./Suite

 

 

 

 

 

 

 

 

City, Town or Post Office

State

ZIP Code

 

 

City, Town or Post Office

State ZIP Code

 

 

 

 

 

 

 

 

 

Daytime Phone (with area code)

 

 

 

 

Daytime Phone (with area code)

 

 

 

 

 

 

 

 

 

Social Security, ITIN, or Other ID No.

Type

 

 

 

Social Security, ITIN, or Other ID No. Type

 

 

|

 

 

 

 

|

 

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

 

TAX TYPE

YEAR(S) OR PERIOD(S)

TYPE OF RETURN/OWNERSHIP

 

Income Tax

 

 

 Corporation

 

 

 

Individual

 

 

 

 

 

 Partnership

 Fiduciary-Estate/Trust

 

Transaction Privilege

 

 Individual/Sole Proprietorship

 Partnership Corporation

Trust

 

and Use Tax

 

 Limited Liability Company

 Limited Liability Partnership

 Estate

Withholding Tax

 

 

 

 

 

 

 

 

 

 

Other (e.g., Luxury Tax):

 

Specify type of return(s)/ownership:

 

 

 

 

 

 

 

 

 

4.NO REVOCATION OF EARLIER AUTHORIZATION(S)

This Disclosure Authorization Form does not revoke any prior Power of Attorney or other authorization forms on file with the department.

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 Taxpayer(s). 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 Taxpayer(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).

By checking this box and signing below I certify under penalty of perjury that I am an officer of the above mentioned corporation(s) and that I am a principal officer, as defined in A.R.S. §42-2003(A)(2).

________________________________________________

_______________________________________________

SIGNATURE

DATE

SIGNATURE

DATE

________________________________________________

_______________________________________________

PRINT NAME

 

PRINT NAME

 

________________________________________________

_______________________________________________

TITLE

 

TITLE

 

ADOR 10955 (8/18)

Document Characteristics

Fact Name Description
Form Purpose The Arizona 285 form is used to authorize the Department of Revenue to release confidential taxpayer information to designated appointees.
Not a Power of Attorney This form does not grant any powers of representation to the appointees, distinguishing it from a Power of Attorney.
Taxpayer Information Taxpayer details such as name, Social Security Number or ITIN, and current address must be provided on the form.
Appointee Information Details about the appointee, including name and contact information, are required, ensuring they can receive the authorized information.
Tax Matters The form specifies which tax types the appointee is authorized to receive information about, such as Income Tax or Transaction Privilege Tax.
No Revocation Filing this form does not revoke any prior authorizations or Power of Attorney documents already on file with the Department.
Signature Requirement The taxpayer must sign the form to certify that they authorize the release of their confidential information.
Legal Authority The form is governed by A.R.S. §42-2003(A), which outlines the authority for executing such authorizations.
Penalties for Fraud Knowingly submitting false information on this form can result in serious legal consequences, including a class 5 felony charge under A.R.S. §42-1127(B)(2).
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