Form 8821 OMB No. 1545-1165

Tax Information Authorization

(Rev. September 1998)

Department of the Treasury

Internal Revenue Service

1 Taxpayer information.

Taxpayer name(s) and address (please type or print) Social security number(s) Employer identification number

Daytime telephone number Plan number (if applicable)

( )

2 Appointee.

CAF No. Name and address (please type or print)

Telephone No.

Fax No.

Telephone No.

Check if new: Address

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.

(a)

Type of Tax

(Income, Employment, Excise, etc.)

(b)

Tax Form Number

(1040, 941, 720, etc.)

(c)

Year(s) or Period(s)

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 2.) ©

4

If you checked this box, skip lines 5 and 6.

5 Disclosure of tax information (you must check box 5a or b unless box 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 above on line 3 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 covered.

© IF THIS AUTHORIZATION IS NOT SIGNED AND DATED, IT WILL BE RETURNED.

Title (if applicable)

Signature Date

Print Name

Cat. No. 11596P Form 8821 (Rev. 9-98)

For IRS Use Only

Telephone

Function

Date / /

Name

( )

( )

( )

Received by:

(d)

Specific Tax Matters (see instr.)

General Instructions

Section references are to the Internal Revenue Code unless

otherwise noted.

Purpose of form. Form 8821 authorizes any individual, corporation,

firm, organization, or partnership you designate to inspect and/or

receive confidential information in any office of the IRS for the type

of tax and the years or periods you list on this 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

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.

For Privacy Act and Paperwork Reduction Act Notice, see page 2.

Title (if applicable)

Signature Date

Print Name

To revoke this tax information authorization, see the instructions on page 2.

you, use Form 2848, Power of Attorney and Declaration of

Representative, instead of 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 the form.

Fiduciaries. 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. File Form 56, Notice Concerning

Fiduciary Relationship, to notify the IRS of the existence of a

Change To Note. New column (d) is added to line 3 for specific tax

matters. Use column (d) to specify tax information that is to be

provided by the IRS. See the line 3 instructions on page 2.
Form 8821 (Rev. 9-98) Page 2

Line 4—Specific use not recorded on CAF. Generally, the IRS

records all tax information authorizations on the CAF system.

However, authorizations relating to a specific issue are not recorded.

Specific Instructions

Line 1—Taxpayer information

Individuals. Enter your name, TIN, and street address in the space

provided. If a joint return is used, also enter your spouse’s name and

TIN. Also enter your EIN if applicable.

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.

Line 6—Retention/revocation of tax information authorizations.

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

authorization you do not want to revoke.

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 7—Signature of taxpayer(s)

Corporations. Generally, Form 8821 can be signed by: (1) an

officer having legal authority to bind the corporation, (2) any person

designated by the board of directors or other governing body, (3) any

officer or employee on written request by any principal officer and

attested to by the secretary or other officer, and (4) any other person

authorized to access information under section 6103(e).

Partnership items. Sections 6221–6231 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 the above-referenced sections.

Line 3—Tax matter(s). 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.

Filing the tax information authorization. File the original,

photocopy, or facsimile transmission (fax) of Form 8821 with each

IRS office in which you want your appointee to inspect and/or

receive confidential tax information on your behalf. If Form 8821 is

filed for a matter currently pending before an office of the IRS, such

as an examination, file the authorization with that office. Otherwise,

file the authorization with the service center where the related return

was, or will be, filed. See the instructions for the related tax return

for the service center addresses. Form 8821 must be received by the

IRS within 60 days of the date it was signed and dated by the

taxpayer.

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 above.

Other. 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, partnerships, or associations. Enter the name,

EIN, and business address.

Line 2—Appointee. Enter the name of your appointee. Use the

identical name on all submissions. If you wish to name more than

one appointee, indicate so on this line and attach a list to the form.

Individuals. You must sign and date the authorization. Either

husband or wife must sign if Form 8821 applies to a joint return.

Note: Only the first three appointees you list will be input on the CAF.

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.

Privacy Act and Paperwork Reduction Act Notice. 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

the form. Under section 6109, you must disclose your social security

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

taxpayer identification number (ITIN).

The time needed to complete and file this form will vary depending

on individual circumstances. The estimated average time is:

Recordkeeping, 7 min.; Learning about the law or the form, 12

min.; Preparing the form, 24 min.; Copying, assembling, and

sending the form to the IRS, 20 min.

If you have comments concerning the accuracy of these time

estimates or suggestions for making this form simpler, we would be

happy to hear from you. You can write to the Tax Forms Committee,

Western Area Distribution Center, Rancho Cordova, CA 95743-0001.

DO NOT send Form 8821 to this address. Instead, see Filing the

tax information authorization on this page.

Note: Filing Form 8821 does not revoke any Form 2848 that is in

effect.

The CAF number is a number that the IRS assigns to appointees.

The appointee must use the CAF number on all future Forms 8821

or 2848. The IRS does not assign CAF numbers to requests for

employee plans and exempt organizations.

In column (c), write the years using the YYYY format, for example,

“1998.” Do not use general references such as “all years,” or “all

periods.” If you do, your application will be returned.

You may list any prior years or periods, but for future periods, you

are limited to the 3 future periods that end no later than 3 years after

the date Form 8821 is received by the IRS. For employment tax or

excise tax returns, enter the applicable quarters of the tax year. For

estate tax returns, enter the date of the taxpayer’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: transcript of an

account, a balance due amount, a specific tax schedule, or a tax

liability.

For requests regarding a foreign certification shown on Form

6166, Certification of Filing A Tax Return, enter “Form 6166” in

column (d) and check the box on line 4.

To revoke an existing authorization, send a copy of the previously

executed Form 8821 to each IRS office where it was filed. Write

“REVOKE” across the top of the form and sign your name again

under the existing signature (line 7). If you do not have a copy of the

prior Form 8821, send a letter to each IRS office where you filed it.

The letter must indicate that the authority of the tax information

authorization is revoked and must be signed by the taxpayer. Include

the name and address of each appointee whose authority is

revoked.

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.

You are not required to provide the information requested on a

form 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. Disclosure of the information on this form may

be made as provided in section 6103.

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

following reasons: (1) requests to disclose information to loan

companies or educational institutions, (2) requests to disclose

information to Federal or state agency investigators for background

checks, (3) civil penalty issues, (4) trust fund recovery penalty, (5)

application for EIN, and (6) claims filed on Form 843, Claim for

Refund and Request for Abatement. If you check the box on line 4,

your appointee should submit a copy of Form 8821 with each written

request to receive information by mail or bring a copy of Form 8821

to each appointment to inspect or receive information. A specific use

tax information authorization does not automatically revoke any prior

tax information authorizations.

fiduciary relationship. 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.