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One of the most popular disclosure forms is:
Disclosure Situation 4
- Consent is sought for
disclosure of tax return information in the context other
than tax return preparation or performance of auxiliary
services; and
- Tax return information will
not be disclosed outside the United States or any territory
or possession of the United States
Federal
law requires this consent form be provided to you. Unless
authorized by law, we cannot use or disclose, without your
consent, your tax return information for purposes other
than the preparation and filing of your tax return. If you
consent to the use or 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. If we obtain your
signature on this form by conditioning our services on your
consent, your consent will not be valid. 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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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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