Consent Form To Disclose Tax Return printable pdf download

CONSENT FORM TO DISCLOSE TAX RETURN INFORMATION UNDER IRS REGULATION §301.7216-3

Federal law requires that this consent form be provided to you. Unless authorized by law, we cannot disclose, without

your written consent, your tax return information to third parties for purposes other than the preparation and filing of

your tax return. If you consent to the disclosure of your tax return information, Federal law may not protect your tax

return information from further use or distribution.

You are not required to complete this form. If we obtain your signature on this form by conditioning our services on

your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do

not specify the duration of your consent, your consent is valid for one year.

Bob McCombs & Company, a U.S.-based firm, may disclose your tax return information to the entities listed below.

The information disclosed may include information furnished to or for or in connection with the preparation of your tax

return(s); information derived or generated by us from the information provided; and/or tax return information

associated with prior years' returns in our possession. The information disclosed may also include all information

contained within your tax return(s); if you wish to request a more limited disclosure of your tax return information you

must inform us.

If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or

without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by

telephone at 1-800-366-4484, or by email at complaints@tigta.treas.gov.

Taxpayer (and Spouse if married) Printed Name: ________________________________________________________

Description of information to be disclosed: _____________________________________________________________

________________________________________________________________________________________________

Name of person or entity(s) information is to be disclosed to: ______________________________________________

Please send my request to (check one) If more than one is indicated there will be an additional charge for each.

[ ] Will pick up

[ ] E-mail address __________________________________________________

[ ] Fax # ___________________

[ ] Mailing address _________________________________________________

Expiration date of this disclosure (if no entry, one year from the date signed): _________________________________

Taxpayer's Signature: _________________________________________

__ __ __ __ __

Date: _____________

Optional Pin Number

Spouse's Signature: ___________________________________________

__ __ __ __ __

Date: _____________

Optional Pin Number

We charge $25 per year for tax return copies including W-2’s and K1’s if requested or $25 for copies of only W-2's

and/or K1’s. We charge $50 for letters of assurance verifying self-employment. Fax, e-mail and first class postage are

included. Next day shipping is charged at actual cost. We accept Mastercard, Visa, and Discover credit and debit cards.

Credit card # __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __

Expiration date __ __ / __ __

Consent Form To Disclose Tax Return