Department of the Treasury - Internal Revenue Service

Employer Appointment of Agent

Under Section 3504 of the Internal Revenue Code

(For use by employers or payers)

OMB Number

1545-0748

1. To Instructions

Employer or Payer: Please complete

this form and give it to the agent.

Agent: Please attach a letter requesting authority to do either all that is

required of the employer for wages you

pay on the employer's behalf or all that is

required of the payer for requirements of

backup withholding. (See applicable

Revenue Procedures 70-6 or 84-33.)

Forward both the letter of request and

Form 2678 to the Director of the Internal

Revenue Service Center where you file

your returns. (See reverse side for

addresses.)

Director

Service Center

Note: Rev. Proc. 70-6 is available in Publication 1271 and Rev. Proc. 84-33 is available in

 Publication 1272,

3. Employer's or Payer's address (Number and street, city, town or post office, State

and ZIP code)

2. Employer's or Payer's name

4. Employer identification number

5. Agent's name 6. Agent's address (Number and street, city, town or post office, State and ZIP code)

7. Agent's employer identification number

10. Effective date of appointment by

 employer or payer

8. Effective for (Check the box or boxes that apply) 9. If filing under Rev, Proc.

 70-6, does this apply to

Employment taxes (Rev. Proc. 70-6) all employees?

Backup withholding (Rev. Proc. 84-33) Yes No

Signature of employer or payer Date Under section 3504 of the Internal Revenue Code,

please authorize this agent to do all that is required

under (Check the one(s) that apply)

Chapter 21 (FICA) Title of signing official (Indicate whether the person signing is an owner,

Chapter 22 (Railroad Retirement) partner, member of firm, fiduciary, or a corporate officer.)

Chapter 24-

Withholding and/or

Backup withholding

Chapter 25 (General Provisions) of Subtitle C

The agent named above has been appointed either

to pay wages for employers and/or report and

deposit backup withholding amounts for payers.

This appointment is effective on the date shown

in Item 10.

It is understood that the agent and the employer or

payer are subject to all provisions of law and

regulations (including penalties) which apply to

employers or payers.

For Internal Revenue Service Use Only

Effective date granted

by IRS

For the Paperwork Reduction Act Notice, please see the back of this form,

Catalog Number 18770D Form 2678 (Rev. 6-97)

Form 2678

(Rev. June 1997)
Paperwork Reduction Act Notice

We ask for this information to carry out the Internal Revenue laws of the United States. We need it to

ensure that taxpayers are complying with these laws and to allow us to figure and collect the right

amount of tax. You are required to give us this information. The time needed to complete this form will

vary depending on individual circumstances. The estimated average time is: 30 minutes. If you have

comments concerning the accuracy of this time estimate or suggestions for making this form more

simple, we would be happy to hear from you. You can write to the Tax Form Committee, Western Area

Distribution Center, Rancho Cordova, CA 95743-0001. DO NOT send this form to this address. Instead,

send it to the Director of the Internal Revenue Service Center where you file your returns.

Holtsville, NY 00501

Andover, MA 05501

Philadelphia, PA 19255

Atlanta, GA 39901

Cincinnati, OH 45999

Austin, TX 73301

Ogden, UT 84201

Kansas City, MO 64999

Fresno, CA 93888

Memphis, TN 37501

Form 2678 (Rev. 6-97)

File with the

Internal Revenue

Service Center at: