Form 8821 OMB No. 1545-1165

Tax Information Authorization

(Rev. April 2004)

Department of the Treasury

Internal Revenue Service

Social security number(s) Employer identification number

3 Tax matters. The appointee is authorized to inspect and/or receive confidential tax information in any office of the IRS for

the tax matters listed on this line. Do not use Form 8821 to request copies of tax returns.

(a)

Type of Tax

(Income, Employment, Excise, etc.)

or Civil Penalty

(b)

Tax Form Number

(1040, 941, 720, etc.)

(c)

Year(s) or Period(s)

(see the instructions for line 3)

Specific use not recorded on Centralized Authorization File (CAF). If the tax information authorization is for a specific

use not recorded on CAF, check this box. See the instructions on page 3. If you check this box, skip lines 5 and 6 

4

5 Disclosure of tax information (you must check a box on line 5a or 5b unless the box on line 4 is checked):

a If you want copies of tax information, notices, and other written communications sent to the appointee on an ongoing

basis, check this box 

b If you do not want any copies of notices or communications sent to your appointee, check this box 

Retention/revocation of tax information authorizations. This tax information authorization automatically revokes all

prior authorizations for the same tax matters you listed on line 3 above unless you checked the box on line 4. If you do

not want to revoke a prior tax information authorization, you must attach a copy of any authorizations you want to remain

in effect and check this box 

6

7 Signature of taxpayer(s). If a tax matter applies to a joint return, either husband or wife must sign. If signed by a

corporate officer, partner, guardian, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify

that I have the authority to execute this form with respect to the tax matters/periods on line 3 above.

 Do not use this form to request a copy or transcript of your tax return.

 Instead, use Form 4506 or Form 4506-T.

Title (if applicable)

Signature Date

Print Name

Cat. No. 11596P Form 8821 (Rev. 4-2004)

For IRS Use Only

Telephone

Function

Date / /

Name

( )

Received by:

(d)

Specific Tax Matters (see instr.)

For Privacy Act and Paperwork Reduction Act Notice, see page 4.

Title (if applicable)

Signature Date

Print Name

To revoke this tax information authorization, see the instructions on page 3.

1 Taxpayer information. Taxpayer(s) must sign and date this form on line 7.

Taxpayer name(s) and address (type or print)

Daytime telephone number Plan number (if applicable)

2 Appointee. If you wish to name more than one appointee, attach a list to this form.

Name and address CAF No.

Telephone No.

Fax No.

Check if new: Address Telephone No.

( )

PIN number for electronic signature PIN number for electronic signature

Fax No.

 IF NOT SIGNED AND DATED, THIS TAX INFORMATION AUTHORIZATION WILL BE RETURNED.
Form 8821 (Rev. 4-2004) Page 2

When To File

IF you live in . . . THEN use this address . . . Fax Number*

Alabama, Arkansas, Connecticut, Delaware,

District of Columbia, Florida, Georgia,

Illinois, Indiana, Kentucky, Louisiana, Maine,

Maryland, Massachusetts, Michigan,

Mississippi, New Hampshire, New Jersey,

New York, North Carolina, Ohio,

Pennsylvania, Rhode Island,

South Carolina, Tennessee, Vermont,

Virginia, or West Virginia

Alaska, Arizona, California, Colorado,

Hawaii, Idaho, Iowa, Kansas, Minnesota,

Missouri, Montana, Nebraska, Nevada,

New Mexico, North Dakota, Oklahoma,

Oregon, South Dakota, Texas, Utah,

Washington, Wisconsin, or Wyoming

Internal Revenue Service

Memphis Accounts Management Center

Stop 8423

5333 Getwell Road

Memphis, TN 38118

Internal Revenue Service

Ogden Accounts Management Center

1973 N. Rulon White Blvd.

Mail Stop 6737

Ogden, UT 84404

901-546-4115

801-620-4249

General Instructions

Section references are to the Internal Revenue Code

unless otherwise noted.

Purpose of Form

Form 8821 does not authorize your appointee to

advocate your position with respect to the Federal tax

laws; to execute waivers, consents, or closing

agreements; or to otherwise represent you before the

IRS. If you want to authorize an individual to represent

you, use Form 2848, Power of Attorney and

Declaration of Representative.

Use Form 56, Notice Concerning Fiduciary

Relationship, to notify the IRS of the existence of a

fiduciary relationship. A fiduciary (trustee, executor,

administrator, receiver, or guardian) stands in the

position of a taxpayer and acts as the taxpayer.

Therefore, a fiduciary does not act as an appointee

and should not file Form 8821. If a fiduciary wishes to

authorize an appointee to inspect and/or receive

confidential tax information on behalf of the fiduciary,

Form 8821 must be filed and signed by the fiduciary

acting in the position of the taxpayer.

Form 8821 authorizes any individual, corporation, firm,

organization, or partnership you designate to inspect

and/or receive your confidential information in any

office of the IRS for the type of tax and the years or

periods you list on Form 8821. You may file your own

tax information authorization without using Form 8821,

but it must include all the information that is requested

on Form 8821. Form 8821 must be received by the IRS within 60 days

of the date it was signed and dated by the taxpayer.

All APO and FPO addresses, American

Samoa, nonpermanent residents of Guam

or the Virgin Islands**, Puerto Rico (or if

excluding income under Internal Revenue

Code section 933), a foreign country:

U.S. citizens and those filing Form 2555,

2555-EZ, or 4563.

Internal Revenue Service

Philadelphia Accounts Management Center

DPSW 312

11601 Roosevelt Blvd.

Philadelphia, PA 19255

215-516-1017

*These numbers may change without notice.

**Permanent residents of Guam should use Department of Taxation, Government of Guam, P.O. Box 23607,

GMF, GU 96921; permanent residents of the Virgin Islands should use: V.I. Bureau of Internal Revenue,

9601 Estate Thomas Charlotte Amaile, St. Thomas, V.I. 00802.

Where To File Chart

Use Form 4506, Request for Copy of Tax Return, to

get a copy of your tax return.

Use new Form 4506-T, Request for Transcript of Tax

Return, to order: (a) transcript of tax account

information and (b) Form W-2 and Form 1099 series

information.

What’s New

Authorization to file Form 8821 electronically. Your

appointee may be able to file Form 8821 with the IRS

electronically. PIN number boxes have been added to

the taxpayer’s signature section. Entering a PIN

number will give your appointee authority to file Form

8821 electronically using the PIN number as the

electronic signature. You can use any five digits other

than all zeroes as a PIN number. You may use the

same PIN number that you used on other filings with

the IRS. See Where To File on page 3 if completing

Form 8821 only for this purpose.
Form 8821 (Rev. 4-2004) Page 3

Specific Instructions

Line 1. Taxpayer Information

Employee plan. Enter the plan name, EIN of the plan

sponsor, three-digit plan number, and business

address of the plan sponsor.

Trust. Enter the name, title, and address of the

trustee, and the name and EIN of the trust.

Estate. Enter the name, title, and address of the

decedent’s executor/personal representative, and the

name and identification number of the estate. The

identification number for an estate includes both the

EIN, if the estate has one, and the decedent’s TIN.

Line 3. Tax Matters

Line 2. Appointee

If you want to name more than one appointee,

indicate so on this line and attach a list of appointees

to Form 8821.

For example, you may list “Income tax, Form 1040”

for calendar year “2003” and “Excise tax, Form 720”

for the “1st, 2nd, 3rd, and 4th quarters of 2003.” For

multiple years, you may list “2001 through (thru or a

dash (—)) 2003” for an income tax return; for quarterly

returns, list “1st, 2nd, 3rd, and 4th quarters of 2001

through 2002” (or 2nd 2002 — 3rd 2003). For fiscal

years, enter the ending year and month, using the

YYYYMM format. Do not use a general reference such

as “All years,”“All periods,” or “All taxes.” Any tax

information authorization with a general reference will

be returned.

You may list any tax years or periods that have

already ended as of the date you sign the tax

information authorization. Also, you may include on a

tax information authorization future tax periods that

end no later than 3 years after the date the tax

information authorization is received by the IRS. The 3

future periods are determined starting after December

31 of the year the tax information authorization is

received by the IRS. You must enter the type of tax,

the tax form number, and the future year(s) or

period(s). If the matter relates to estate tax, enter the

date of the decedent’s death instead of the year or

period.

In column (d), enter any specific information you

want the IRS to provide. Examples of column (d)

information are: lien information, a balance due

amount, a specific tax schedule, or a tax liability.

For requests regarding Form 8802, Application for

United States Residency Certification, enter “Form

8802” in column (d) and check the specific use box on

line 4. Also, enter the appointee’s information as

instructed on Form 8802.

Enter your appointee’s full name. Use the identical full

name on all submissions and correspondence. Enter

the nine-digit CAF number for each appointee. If an

appointee has a CAF number for any previously filed

Form 8821 or power of attorney (Form 2848), use that

number. If a CAF number has not been assigned, enter

“NONE,” and the IRS will issue one directly to your

appointee. The IRS does not assign CAF numbers to

requests for employee plans and exempt organizations.

Enter the type of tax, the tax form number, the years

or periods, and the specific tax matter. Enter “Not

applicable,” in any of the columns that do not apply.

Partnership Items

Taxpayer Identification Numbers (TINs)

TINs are used to identify taxpayer information with

corresponding tax returns. It is important that you

furnish correct names, social security numbers (SSNs),

individual taxpayer identification numbers (ITINs), or

employer identification numbers (EINs) so that the IRS

can respond to your request.

Sections 6221–6234 authorize a Tax Matters Partner to

perform certain acts on behalf of an affected

partnership. Rules governing the use of Form 8821 do

not replace any provisions of these sections.

Individuals. Enter your name, TIN, and your street

address in the space provided. Do not enter your

appointee’s address or post office box. If a joint return

is used, also enter your spouse’s name and TIN. Also

enter your EIN if applicable.

Corporations, partnerships, or associations. Enter

the name, EIN, and business address.

Where To File

Generally, mail or fax Form 8821 directly to the IRS.

See the Where To File Chart on page 2. Exceptions

are listed below.

● If Form 8821 is for a specific tax matter, mail or fax it

to the office handling that matter. For more

information, see the instructions for line 4.

● If you complete Form 8821 only for the purpose of

electronic signature authorization, do not file Form

8821 with the IRS. Instead, give it to your appointee,

who will retain the document.

If you want to revoke an existing tax information

authorization and do not want to name a new

appointee, send a copy of the previously executed tax

information authorization to the IRS, using the Where

To File Chart on page 2. The copy of the tax

information authorization must have a current signature

of the taxpayer under the original signature on line 7.

Write “REVOKE” across the top of Form 8821. If you

do not have a copy of the tax information authorization

you want to revoke, send a statement to the IRS. The

statement of revocation must indicate that the

authority of the tax information authorization is

revoked, list the tax matters, must be signed and

dated by the taxpayer, and list the name and address

of each recognized appointee whose authority is

revoked.

Revocation of an Existing Tax Information

Authorization

To revoke a specific use tax information

authorization, send the tax information authorization or

statement of revocation to the IRS office handling your

case, using the above instructions.

Check the appropriate box to indicate if either the

address, telephone number, or fax number is new since

a CAF number was assigned.
Form 8821 (Rev. 4-2004) Page 4

The time needed to complete and file this form will

vary depending on individual circumstances. The

estimated average time is: Recordkeeping, 6 min.;

Learning about the law or the form, 12 min.;

Preparing the form, 24 min.; Copying and sending

the form to the IRS, 20 min.

If you have comments concerning the accuracy of

these time estimates or suggestions for making Form

8821 simpler, we would be happy to hear from you.

You can write to the Tax Products Coordinating

Committee, Western Area Distribution Center, Rancho

Cordova, CA 95743-0001. Do not send Form 8821 to

this address. Instead, see the Where To File Chart on

page 2.

You are not required to provide the information

requested on a form that is subject to the Paperwork

Reduction Act unless the form displays a valid OMB

control number. Books or records relating to a form or

its instructions must be retained as long as their

contents may become material in the administration of

any Internal Revenue law.

Privacy Act and Paperwork Reduction Act

Notice

Routine uses of this information include giving it to

the Department of Justice for civil and criminal

litigation, and to cities, states, and the District of

Columbia for use in administering their tax laws. We

may also give this information to other countries

pursuant to tax treaties. We may also disclose this

information to Federal and state agencies to enforce

Federal nontax criminal laws and to combat terrorism.

The authority to disclose information to combat

terrorism expired on December 31, 2003. Legislation is

pending that would reinstate this authority.

Partnerships. Generally, Form 8821 can be signed

by any person who was a member of the partnership

during any part of the tax period covered by Form

8821. See Partnership Items on page 3.

All others. See section 6103(e) if the taxpayer has

died, is insolvent, is a dissolved corporation, or if a

trustee, guardian, executor, receiver, or administrator is

acting for the taxpayer.

Corporations. Generally, Form 8821 can be signed

by: (a) an officer having legal authority to bind the

corporation, (b) any person designated by the board of

directors or other governing body, (c) any officer or

employee on written request by any principal officer

and attested to by the secretary or other officer, and

(d) any other person authorized to access information

under section 6103(e).

Line 4. Specific Use Not Recorded on CAF

Line 6. Retention/Revocation of Tax

Information Authorizations

Line 7. Signature of Taxpayer(s)

Individuals. You must sign and date the

authorization. Either husband or wife must sign if Form

8821 applies to a joint return.

Check the box on line 4 if Form 8821 is filed for any of

the following reasons: (a) requests to disclose

information to loan companies or educational

institutions, (b) requests to disclose information to

Federal or state agency investigators for background

checks, (c) application for EIN, or (d) claims filed on

Form 843, Claim for Refund and Request for

Abatement. If you check the box on line 4, your

appointee should mail or fax Form 8821 to the IRS

office handling the matter. Otherwise, your appointee

should bring a copy of Form 8821 to each

appointment to inspect or receive information. A

specific-use tax information authorization will not

revoke any prior tax information authorizations.

Check the box on this line and attach a copy of the

tax information authorization you do not want to

revoke. The filing of Form 8821 will not revoke any

Form 2848 that is in effect.

Generally, the IRS records all tax information

authorizations on the CAF system. However,

authorizations relating to a specific issue are not

recorded.

We ask for the information on this form to carry out

the Internal Revenue laws of the United States. Form

8821 is provided by the IRS for your convenience and

its use is voluntary. If you designate an appointee to

inspect and/or receive confidential tax information, you

are required by section 6103(c) to provide the

information requested on Form 8821. Under section

6109, you must disclose your social security number

(SSN), employer identification number (EIN), or

individual taxpayer identification number (ITIN). If you

do not provide all the information requested on this

form, we may not be able to honor the authorization.