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. 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. If you agree to the
disclosure of your tax return information, 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.
Duration of consent (optional): _____________________
I, ____________________________________________ authorize
Wellman Hoff
(name of
taxpayer)
to disclose
________________________________________________________
(specify tax
return information to be disclosed)
to
_______________________________________________________________
(identify the recipient of the tax return information)
for the purpose of __________________________________________________.
(specify the intent(s) of the
disclosure)
Signature: ________________________________________________________
Date: __________________________
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.