Form Rev185 - Authorization To Release Tax Information
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1REV185
Authorization to Release Tax Information
Read the instructions on the back before completing this form.
Your name or name of entity
Social Security, Minnesota ID, or federal ID number
Spouse’s name, if joint (or corporate officer, partner or fiduciary if a business)
Spouse’s Social Security number (if a joint return)
Street address
City
State
Zip code
I authorize the following person or organization to inspect and/or receive private and nonpublic information in regard to the tax
types and periods provided below.
Name of person or organization to receive tax information
Name of firm (if applicable)
Street address
City
State
Zip code
Phone number
FAX number
(
)
(
)
The above person or organization is authorized to receive the following tax information (check all that apply):
Type of tax
Year(s) or period(s)
Type of tax
Year(s) or period(s)
Individual income
Sales and use
Property tax refund
Withholding
Corporate franchise
Other (please specify):
The authorization to release tax information is not valid until it is signed and dated. It will expire once the information is released.
Your signature or signature of corporate officer, partner or fiduciary
Print your name (and title, if applicable)
Date
Phone
(
)
Spouse’s signature (if joint)
Print spouse’s name (if joint)
Date
Phone
(
)
Mail to: Minnesota Department of Revenue, Mail Station 7703, St. Paul, MN 55146-7703
(Rev. 12/10)
Stock No. 6000185
Form REV185 instructions
Purpose of this form
Your signature
Questions?
You must complete, sign and return this
The authorization to release tax informa-
If you have questions on how to complete
form if you want to authorize a person
tion is not valid until it is signed and dated.
this form, call (651) 296-3781 or
or organization to inspect and/or receive
Your spouse may also sign if joint returns
1-800-652-9094.
certain private or nonpublic information
are listed.
TTY users, call Minnesota Relay at 711.
concerning your state taxes.
Your signature at the bottom of this form
By completing and signing this form, you
authorizes the individual or organization
are authorizing the department to release
you designate to only be able to inspect and/
tax information to the person or organiza-
or receive confidential tax information on
tion you designate.
your behalf.
The department will accept copies of the
form, including those from a FAX machine.
This authorization will expire once the
information is released to the person or
organization you have indicated.
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