Us Department Of Justice Tax Check Waiver printable pdf download

TO BE USED FOR INITIAL INVESTIGATIONS OF

NEW HIR ES O NLY ; NOT FOR REINVESTIGATIONS, HIRING OF

SAUSAs OR FBI NON-AGENT ATTORNEYS, OR JUDICIAL AND

PRESIDENTIAL APPOINTMEN TS

U.S. Department of Justice

Tax Check Waiver

Please complete both sides of this form

A. Information the Internal Revenue Service Will Provide the U.S. Department of Justice

I am signing this waiver to permit the Internal Revenue Service (IRS) to release information about me

which would otherwise be confidential. This information will be used in connection with my

appointment or employment by the United States Government. This waiver is made pursuant to 26

U.S.C. § 6103(c).

I request that the Internal Revenue Service release the following information to Louis DeFalaise,

Director, Office of Attorney Recruitment & Management, U.S. Department of Justice (or

designee):

Whether I have failed to file any Federal income tax return for any of the last three years for

which filing of a return might have been required. (If the filing date without regard to extensions

and normal processing period for most recent year's return has not yet elapsed on the date IRS

receives this waiver, and the IRS records do not indicate a return for the most recent year, the

"last three years" will mean the three years preceding the year for which returns are currently

being filed and processed.)

Whether any of the returns in #1 were filed more than 45 days after the due date for filing

(determined with regard to any extension(s) of time for filing).

Whether I have failed to pay any tax, penalty or interest during the current or last three calendar

years within 45 days of the date on which the IRS gave notice of the amount due and requested

payment.

Whether I am now or have ever been under investigation by the IRS for possible criminal

offenses.

Whether any civil penalty for fraud has been assessed against me during the current or last three

calendar years.

I authorize the IRS to release any additional relevant information necessary to respond to the questions

above.

B. Information I Am Providing to the U.S. Department of Justice and Internal Revenue

Service

To help the IRS find my tax records, and to help the Department of Justice evaluate my tax

history prior to receipt of the information requested above, I am voluntarily giving the following

information and answering the following questions:

(OVER)

Us Department Of Justice Tax Check Waiver