Printable Version

Adele’s Tax Service (“we,” “us,” and “our”)

Federal law requires this consent form to be provided to you. 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 you specify. If you do not specify the duration of your consent, your consent is valid for one year.

Information to be disclosed: _______ tax return for _________

other:_________________________________________________________________

Intended purpose of disclosure:________ mortgage, loan, or other financing

other:_________________________________________________________________

Intended recipient:_______________________________________________________

Printed name of Taxpayer:_________________________________________________

Taxpayer signature:_____________________________________ ____Date:_________

Duration of consent:________ one year ______ until revoked in writing

Printed name of Taxpayer:_________________________________________________

Taxpayer signature:_________________________________________ Date:_________

Duration of consent:________ one year ______ until revoked in writing

If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email to: complaints@tigta.treas.gov.