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.
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.
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
Current Address (if different from taxpayer’s address above)
Apt./Suite
State ZIP 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
________________________________________________
_______________________________________________
PRINT NAME
TITLE
ADOR 10955 (8/18)
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