HomeMy WebLinkAboutConfidential Tax Information Authorization
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City of Renton Tax & Licensing • 1055 S Grady Way, Renton, WA 98057 • 425-430-6851 • taxandlicensing@rentonwa.gov • rentonwa.gov
City of Renton Tax & Licensing Confidential Tax Information Authorization
THE REPRESENTATIVE NAMED ON THIS DOCUMENT IS AUTHORIZED TO
RECEIVE CONFIDENTIAL TAX INFORMATION FROM THE CITY OF RENTON.
THIS FORM WILL BE PLACED IN THE TAXPAYER’S FILE.
TAXPAYER/BUSINESS INFORMATION
Renton Account #: Phone:
UBI#: Email:
Taxpayer name: Fax:
Taxpayer address:
REPRESENTATIVE
Name: Phone:
Title: Email:
Address:
Fax:
AUTHORIZATION
Information Authorized:
(Be specific or state ALL)
Year/Period Authorized:
(Be specific or state ALL)
REVOCATION OF TAX INFORMATION AUTHORIZATION
Check the box if you would like to revoke a prior confidential tax information authorization: ☐
SIGNATURE OF TAXPAYER
I certify that I am shown in official Washington state records as the owner, corporate officer, registered agent, or
partner of the above business/account and that I am authorized to execute this form on behalf of the
business/account for the information and periods stated above. If you are the guardian, executor, receiver,
administrator, or trustee, please provide proof of your authorization.
Signature:
Date:
Name:
Title:
Signature:
Date:
Name:
Title: