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One of the most popular disclosure forms for clients located outside
of the USA:
Disclosure Situation 3
- Consent is sought for disclosure of tax return
information in the context of tax return preparation or
performance of auxiliary services; and
- Tax return information will be disclosed outside the
United States or any territory or possession of the United
States
- Disclosure includes the taxpayer’s social security
number, or
- Disclosure includes a document where the social security
number is not fully masked or otherwise redacted
- Note that in order to disclose a taxpayer’s social
security number to a tax return preparer located outside of
the United States, both the tax return preparer located
within the United States and the tax return preparer located
outside of the United States must maintain an adequate data
protection safeguard at the time the taxpayer’s consent is
obtained and when making the disclosure. Rev. Proc. 2008-35
§ 4.07.
- An exception to the consent requirement exists where a
tax return preparer located within the United States
initially receives a social security number from a tax
return preparer located outside of the United States and the
preparer within the United States retransmits the social
security number to the preparer that initially provided it.
Treas. Reg. § 301.7216-3(b)(4).
Federal
law requires this consent form be provided to you. Unless
authorized by law, we cannot disclose, without your
consent, your tax return information to third parties
for purposes other than the preparation and filing of your tax
return and, in certain limited circumstances, for purposes
involving tax return preparation. 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.
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You are not required to complete this form. Because our ability to
disclose your tax return information to another tax return
preparer affects the service that we provide to you and its cost,
we may decline to provide you with service or change the terms of
service that we provide to you if you do not sign this form. If
you agree to the use or disclosure of your tax return
information, your consent is valid until or if you subsequently
revoke your consent. If you would like us to use and disclose
your tax return information to your mortgage broker, banker,
lawyer, etc., please sign and date this consent form.
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This
consent to disclose may result in your tax return information
being disclosed to a tax return preparer located outside the
United States, including your personally identifiable information
such as your Social Security Number ("SSN"). Both the tax return
preparer in the United States that will disclose your SSN and the
tax return preparer located outside the United States which will
receive your SSN maintain an adequate data protection safeguard
(as required by the regulations under 26 U.S.C. Section 7216) to
protect privacy and prevent unauthorized access of tax return
information. If you consent to the disclosure of your tax return
information, Federal agencies may not be able to enforce U.S. laws
that protect the privacy of your tax return information against a
tax return preparer located outside of the U.S. to which the
information is disclosed.
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I,
[Insert
name of taxpayer - in the
Electronic "Signature" Submission
Form] authorize Colin M. Cody, CPA,
CMA to use for updating me or disclose to my mortgage broker, banker, lawyer etc., as applicable,
for any purpose. [specify
any restrictions or additional tax return to be disclosed/used - in "special instructions"
section
of the Electronic "Signature" Submission
Form]
I understand that I have the right to limit the consent to
specific information, not just authorize use or disclosure of
the entire return(s).
Recognizing that right, I consent to the use and disclosure of
my entire tax return(s).
This consent will remain valid until or if I revoke it.
Note: If there are multiple reasons for requesting consent to use
or disclose tax return information they may all be listed in one consent
form. See Revenue Procedure 2008-35, section 6
for examples.
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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
Signature: (indicate by typing "CONSENT" below): |
Date: |
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