Form 156 - Maryland Authorization For The Release Of Tax Records/information
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1AUTHORIZATION FOR THE RELEASE OF
FORM
156
TAX RECORDS/INFORMATION
I hereby authorize the Comptroller of Maryland to release the confidential Maryland tax records and information of:
TAXPAYER*:
*Also known as
SOCIAL SECURITY NUMBER
DATE OF BIRTH
PHONE NUMBER
STREET ADDRESS
CITY
STATE
ZIP CODE
The information is to be released to:
NAME
AGENCY
STREET ADDRESS
CITY
STATE
ZIP CODE
PHONE NUMBER
Any and all tax records and/or information (including liabilities, delinquencies, liens, etc.) for the following years:
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Other
The purpose for such disclosure is:
At my request
Payment/Insurance
Healthcare
Employment
Other: _____________
This authorization will expire one year from the date it is signed unless a shorter period of time is indicated here:
___________________________________________________________________________________________________
Authorization For The Release of Tax Records
I understand:
• This authorization is voluntary.
• I may receive a copy of this form.
• I may inspect my confidential tax information without signing this form.
• This authorization to disclose information may be revoked by me at any time, except to the extent that action has been taken
prior to receipt of revocation. To revoke the authorization, I understand that I must notify the Comptroller of Maryland in writing.
Taxpayer or Personal Representative’s Signature
Date
Printed Name of Taxpayer or Personal Representative
Phone Number
If the signature is other than the taxpayer’s, explain your authority to act for the taxpayer, and attach the appropriate documentation
(Power of Attorney, Letter of Administration, etc.):
Signature of Witness
Date
Printed Name of Witness
MAIL TO:
Legal Section
FAX:
410-974-2968
Comptroller of Maryland
Revenue Administration Division
110 Carroll Street
Annapolis, Maryland 21411
OFFICE USE ONLY
Tax Year(s)
Account No.(s)
Taxpayer’s Signature(s) verified by
Photocopied by
Reviewed by
Researcher’s Initials
Date
Date Copies/Info Released
COM/RAD 756
(Rev. 02/13)
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