Consent to Disclosure of Tax Return Information

  Federal law requires this consent form be provided to you (“you” refers to each taxpayer, if more than one). 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.

You have indicated that you are interested in <enter product or service here> from <enter third party organization here>. In order to facilitate this arrangement, we must disclose all of your 2008 tax return information to <enter third party organization here>. You may request a more limited disclosure of tax return information, provided that you authorize disclosure of all the information required by <enter third party organization here> to consider your application.

 If you would like us to disclose your 2008 tax return information to <enter third party organization here> for this purpose, please sign and date your consent to the disclosure of your tax return information.

By signing below, you (including each of you if there is more than one taxpayer) authorize us to disclose to <enter third party organization here> all of your 2008 tax return information so that <enter third party organization here> can evaluate and process your application. You understand that if you are not willing to authorize us to share your tax information with <enter third party organization here>, you will not be able to obtain <enter product or service here> from <enter third party organization here>, but you can still choose to have your tax return prepared and filed by us for a fee.

 Printed Name of Taxpayer:_________________________________________________

 Taxpayer Signature:_______________________________       Date:_______________

 Printed Name of Joint Taxpayer:_____________________________________________

 Joint Taxpayer 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 e-mail at complaints@tigta.treas.gov.