Instructions

This consent is required in order for us to disclose your tax returns to any third-party.  Complete each field and then click "submit."  If you wish to print the consent and fax or mail to us click here.

Field by field instructions:

Purpose for forwarding information
Enter the reason you are requesting that we disclose your tax information to a third-party.  Reasons may include "applying for a loan," "bonding requirements," "licensing application," etc.

Name and address to whom the information is being disclosed to
Enter the institution name, contact person and either the mailing address, email address, fax number or other delivery instructions. (i.e. First City Bank, john@firstcitybank.com).

Duration of Consent (if blank this consent will be valid for one year)
Enter the length of time that this consent is valid (i.e. 2 weeks, 1 year, until December 31, 2010, etc.).

Tax year
Enter the year(s) of the tax returns that you are requesting that we disclose (i.e. 2008, 2006-2007, etc.).

Taxpayer's Name
Enter the taxpayer's(s') name as it appears on the tax return.

Signature and Date
We cannot honor your request without your electronic signature and the date signed.  Please type in capital letters.

Title
If you are signing on behalf of an entity such as a corporation or partnership enter your title or position (i.e. President)

Personal ID Number
Enter the five digit PIN assigned to you by our firm.

Tax Return Disclosure Consent

159*_*Form Title