Consent to Disclose Tax Return/Financial Statement Information (To be used for taxpayer requests only)
Tax Return/Financial Statement Preparer: Brink, Key & Chludzinski, P.C.
Purpose of Consent: To satisfy taxpayer request to disclose tax return/financial statement information to:
Describe tax return/financial statement information to be disclosed including tax periods, whether the disclosure will include the entire tax return and whether additional supporting documents are to be provided (i.e. K-1's, 1099s, etc), and/or including financial statement period ending date and whether the disclosure will include the entire financial statement:
Forms and Tax Year(s) or (i.e 1040, 1065, 1120, 1120s, 5500, 1041, etc.)
Entire Tax Return and/or Financial Statement:
If no, describe what is to be included (i.e. pages/schedules/attachments)
We generally are not authorized to disclose your tax return or financial statement information to third parties. We may only disclose your tax return and/or financial statement information to third parties if you consent to each specific disclosure. We will not disclose the tax return and/or financial statement information for any purpose (not otherwise permitted by law without formal consent) other than that stated in this consent.
WARNING: Once your tax return and/or financial statement information is disclosed to a third party per your consent, we have no control over what that third party does with your tax return or financial statement information. If the third party uses or disclosed your tax return or financial statement information for purposes other than the purpose for which you authorized the disclosure, we are not responsible for that unauthorized disclosure, and federal tax law may not protect that unauthorized disclosure.
If you would like Brink, Key & Chludzinski, P.C. to disclose your tax return and/or financial statement information described above to the above referenced third party, please provide the information requested below and sign and date your consent to the disclosure of your tax return and/or financial statement information.
I, , authorize Brink, Key & Chludzinski, P.C. to disclose to the above referenced third party the tax return/financial information described above. I understand that if my consent authorizes the disclosure of all information contained within a tax return or financial statement, a more limited disclosure may satisfy the purpose of the consent. Disclosure of the tax return and/or financial statement information described above has been specifically requested by my.
