Common use of Disclosure Authorization Clause in Contracts

Disclosure Authorization. 18 a The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Form W-2 series information returns. This authority is effective for calendar year forms beginning . b The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Form 1099 series information returns. This authority is effective for calendar year forms beginning . c The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Forms 3921 and 3922. This authority is effective for calendar year forms beginning . State or Local Authorization (Caution: See Authorization Agreement) 19 Check here to authorize the reporting agent to sign and file state or local returns related to the authorization granted on line 15 and/or line 16 ✔ Authorization Agreement I understand that this agreement does not relieve me, as the taxpayer, of the responsibility to ensure that all tax returns are filed and that all deposits and payments are made and that I may enroll in the Electronic Federal Tax Payment System (EFTPS) to view deposits and payments made on my behalf. If line 15 is completed, the reporting agent named above is authorized to sign and file the return indicated, beginning with the quarter or year indicated. If any starting dates on line 16 are completed, the reporting agent named above is authorized to make deposits and payments beginning with the period indicated. Any authorization granted remains in effect until it is revoked by the taxpayer or reporting agent. I am authorizing the IRS to disclose otherwise confidential tax information to the reporting agent relating to the authority granted on line 15 and/or line 16, including disclosures required to process Form 8655. Disclosure authority is effective upon signature of taxpayer and IRS receipt of Form 8655. The authority granted on Form 8655 will not revoke any Power of Attorney (Form 2848) or Tax Information Authorization (Form 8821) in effect. I certify I have the authority to execute this form and authorize disclosure of otherwise confidential information on behalf of the taxpayer. Sign Here ▶ Signature of taxpayer ▶ Title ▶ Date For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. Xx. 00000X Xxxx 0000 (Xxx. 8-2014) STATE OF SOUTH CAROLINA SOUTH CAROLINA DEPARTMENT OF EMPLOYMENT & WORKFORCE 0000 XXXXXXX XXXXXX ~ XXXX XXXXXX XXX 000 XXXXXXXX, XX 00000 ELECTRONIC FUNDS TRANSFER AGREEMENT SCDEW Account # FID # Account Name and Address This is an agreement between the South Carolina Department of Employment & Workforce, (hereinafter SCDEW), and ( “the Employer”), entered into on this the day of . The SCDEW and the Employer agree as follows:

Disclosure Authorization. 18 a The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Form W-2 series information returns. This authority is effective for calendar year forms beginning . b The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Form 1099 series information returns. This authority is effective for calendar year forms beginning . c The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Forms 3921 and 3922. This authority is effective for calendar year forms beginning . State or Local Authorization (Caution: See Authorization Agreement) 19 Check here to authorize the reporting agent to sign and file state or local returns related to the authorization granted on line 15 and/or line 16 ✔ Authorization Agreement I understand that this agreement does not relieve me, as the taxpayer, of the responsibility to ensure that all tax returns are filed and that all deposits and payments are made and that I may enroll in the Electronic Federal Tax Payment System (EFTPS) to view deposits and payments made on my behalf. If line 15 is completed, the reporting agent named above is authorized to sign and file the return indicated, beginning with the quarter or year indicated. If any starting dates on line 16 are completed, the reporting agent named above is authorized to make deposits and payments beginning with the period indicated. Any authorization granted remains in effect until it is revoked by the taxpayer or reporting agent. I am authorizing the IRS to disclose otherwise confidential tax information to the reporting agent relating to the authority granted on line 15 and/or line 16, including disclosures required to process Form 8655. Disclosure authority is effective upon signature of taxpayer and IRS receipt of Form 8655. The authority granted on Form 8655 will not revoke any Power of Attorney (Form 2848) or Tax Information Authorization (Form 8821) in effect. I certify I have the authority to execute this form and authorize disclosure of otherwise confidential information on behalf of the taxpayer. Sign Here ▶ Signature of taxpayer ▶ Title ▶ Date For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. Xx. 00000X Xxxx 0000 (Xxx. 8-2014) ACD - 31102 Rev 00-0000 Xxxxx xx Xxx Xxxxxx - Taxation and Revenue Department TAX INFORMATION AUTHORIZATION oTaxpayer Name o Business Name o NM ID o SSN o FEIN o EIN oTaxpayer Address o Business Address Telephone Number City State Zip Code Hereby authorizes Address: Telephone Number: to represent me and/or my business pertaining to taxes administered by the New Mexico Taxation and Revenue Department.* IF IRS INFORMATION IS INVOLVED, BE SURE TO OBTAIN FORM 2848 OR FORM 8821, AS APPLICABLE. CHECK ALL ITEMS THAT APPLY q all state taxes FOR q any year q CRS taxes OR q income taxes q specify specific year(s) q specify others I certify that I have the authority to execute this tax information authorization.** Print Name Title Date Signature Title Date * The taxpayer may limit the scope of this authorization by specifying the particular information or tax types to be handled by the authorized person. ** For joint returns, both taxpayers must sign. If not signed by the taxpayer, signature must be that of a corporate officer, partner, or fiduciary on behalf of the taxpayer. STATE OF SOUTH CAROLINA SOUTH CAROLINA NEW MEXICO DEPARTMENT OF EMPLOYMENT & WORKFORCE 0000 XXXXXXX XXXXXX ~ XXXX XXXXXX XXX 000 XXXXXXXXSOLUTIONS WORKFORCE TRANSITION SERVICES POWER OF ATTORNEY/AUTHORIZATION OF AGENT NOTICE: THIS IS AN IMPORTANT DOCUMENT. THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING. IF YOU HAVE ANY QUESTIONS ABOUT THESE POWERS, XX 00000 ELECTRONIC FUNDS TRANSFER AGREEMENT SCDEW YOU SHOULD ASK A LAWYER TO EXPLAIN THEM TO YOU. THIS FORM DOES NOT PROHIBIT THE USE OF ANY OTHER FORM. YOU MAY REVOKE THIS POWER OF ATTORNEY IF YOU LATER WISH TO DO SO. Legal Employer Name Employer Account # FID # Account Number Trade Name and - DBA (if applicable) Federal ID Number Official Mailing Address This is an agreement between the South Carolina Department of Employment & WorkforceCity, (hereinafter SCDEW)State, and ( “the Employer”)Zip Code Phone Number DOES HEREBY APPOINT AS THE DULY AUTHORIZED ATTORNEY-IN-FACT/AGENT: Name Address Phone Number City, entered into on this the day of . The SCDEW and the Employer agree as follows:State, Zip Code

Disclosure Authorization. 18 a The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Form W-2 series information returns. This authority is effective for calendar year forms beginning . b The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Form 1099 series information returns. This authority is effective for calendar year forms beginning . c The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Forms 3921 and 3922. This authority is effective for calendar year forms beginning . State or Local Authorization (Caution: See Authorization Agreement) 19 Check here to authorize the reporting agent to sign and file state or local returns related to the authorization granted on line 15 and/or line 16 ✔ Authorization Agreement I understand that this agreement does not relieve me, as the taxpayer, of the responsibility to ensure that all tax returns are filed and that all deposits and payments are made and that I may enroll in the Electronic Federal Tax Payment System (EFTPS) to view deposits and payments made on my behalf. If line 15 is completed, the reporting agent named above is authorized to sign and file the return indicated, beginning with the quarter or year indicated. If any starting dates on line 16 are completed, the reporting agent named above is authorized to make deposits and payments beginning with the period indicated. Any authorization granted remains in effect until it is revoked by the taxpayer or reporting agent. I am authorizing the IRS to disclose otherwise confidential tax information to the reporting agent relating to the authority granted on line 15 and/or line 16, including disclosures required to process Form 8655. Disclosure authority is effective upon signature of taxpayer and IRS receipt of Form 8655. The authority granted on Form 8655 will not revoke any Power of Attorney (Form 2848) or Tax Information Authorization (Form 8821) in effect. I certify I have the authority to execute this form and authorize disclosure of otherwise confidential information on behalf of the taxpayer. Sign Here ▶ Signature of taxpayer ▶ Title ▶ Date For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. Xx. 00000X Xxxx 0000 (Xxx. 8-2014) STATE REV-677 LE (05-14) POWER OF SOUTH CAROLINA SOUTH CAROLINA DEPARTMENT ATTORNEY AND DECLARATION OF EMPLOYMENT & WORKFORCE 0000 XXXXXXX XXXXXX ~ XXXX XXXXXX XXX 000 XXXXXXXXREPRESENTATIVE GENERAL INSTRUCTIONS: This form provides limited authority for department representatives to speak about confidential tax matters with designated third parties. Such authority is limited to the tax period, XX 00000 ELECTRONIC FUNDS TRANSFER AGREEMENT SCDEW Account # FID # Account Name and Address This is an agreement between the South Carolina Department of Employment & Workforce, (hereinafter SCDEW), and ( “the Employer”), entered into on this the day of . The SCDEW tax type and the Employer agree specific issue/purpose identified herein. While tax practitioners are encouraged to maintain appropriate declarations of authority to handle clients' tax matters within their own records, tax practitioners should not submit unsolicited REV-677 forms to the department en masse or as follows:a matter of routine. Such forms will be disregarded. A REV-677 form should only be submitted to an individual within the department upon an agent's request for such authorization. If a department representative has requested a REV-677 form to authorize discussion of confidential tax matters with a third party, please return the form to the department representative as requested.

Disclosure Authorization. 18 a The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Form W-2 series information returns. This authority is effective for calendar year forms beginning . b The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Form 1099 series information returns. This authority is effective for calendar year forms beginning . c The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Forms 3921 and 3922. This authority is effective for calendar year forms beginning . State or Local Authorization (Caution: See Authorization Agreement) 19 Check here to authorize the reporting agent to sign and file state or local returns related to the authorization granted on line 15 and/or line 16 ✔ Authorization Agreement I understand that this agreement does not relieve me, as the taxpayer, of the responsibility to ensure that all tax returns are filed and that all deposits and payments are made and that I may enroll in the Electronic Federal Tax Payment System (EFTPS) to view deposits and payments made on my behalf. If line 15 is completed, the reporting agent named above is authorized to sign and file the return indicated, beginning with the quarter or year indicated. If any starting dates on line 16 are completed, the reporting agent named above is authorized to make deposits and payments beginning with the period indicated. Any authorization granted remains in effect until it is revoked by the taxpayer or reporting agent. I am authorizing the IRS to disclose otherwise confidential tax information to the reporting agent relating to the authority granted on line 15 and/or line 16, including disclosures required to process Form 8655. Disclosure authority is effective upon signature of taxpayer and IRS receipt of Form 8655. The authority granted on Form 8655 will not revoke any Power of Attorney (Form 2848) or Tax Information Authorization (Form 8821) in effect. I certify I have the authority to execute this form and authorize disclosure of otherwise confidential information on behalf of the taxpayer. Sign Here ▶ Signature of taxpayer ▶ Title ▶ Date For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. Xx. 00000X Xxxx 0000 (Xxx. 8-2014) STATE OF SOUTH CAROLINA SOUTH CAROLINA ARIZONA FORM 000-XXX XXXXX XX XXXXXXX • DEPARTMENT OF EMPLOYMENT & WORKFORCE 0000 XXXXXXX XXXXXX ~ XXXX XXXXXX XXX 000 XXXXXXXX, XX 00000 ELECTRONIC FUNDS TRANSFER AGREEMENT SCDEW Account # FID # Account Name and Address This is an agreement between the South Carolina Department of Employment & Workforce, (hereinafter SCDEW), and ( “the Employer”), entered into on this the day of . The SCDEW and the Employer agree as follows:REVENUE Withholding Tax Payroll Service Company Authorization

Disclosure Authorization. 18 a The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Form W-2 series information returns. This authority is effective for calendar year forms beginning . b The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Form 1099 series information returns. This authority is effective for calendar year forms beginning . c The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Forms 3921 and 3922. This authority is effective for calendar year forms beginning . State or Local Authorization (Caution: See Authorization Agreement) 19 Check here to authorize the reporting agent to sign and file state or local returns related to the authorization granted on line 15 and/or line 16 ✔ Authorization Agreement I understand that this agreement does not relieve me, as the taxpayer, of the responsibility to ensure that all tax returns are filed and that all deposits and payments are made and that I may enroll in the Electronic Federal Tax Payment System (EFTPS) to view deposits and payments made on my behalf. If line 15 is completed, the reporting agent named above is authorized to sign and file the return indicated, beginning with the quarter or year indicated. If any starting dates on line 16 are completed, the reporting agent named above is authorized to make deposits and payments beginning with the period indicated. Any authorization granted remains in effect until it is revoked by the taxpayer or reporting agent. I am authorizing the IRS to disclose otherwise confidential tax information to the reporting agent relating to the authority granted on line 15 and/or line 16, including disclosures required to process Form 8655. Disclosure authority is effective upon signature of taxpayer and IRS receipt of Form 8655. The authority granted on Form 8655 will not revoke any Power of Attorney (Form 2848) or Tax Information Authorization (Form 8821) in effect. I certify I have the authority to execute this form and authorize disclosure of otherwise confidential information on behalf of the taxpayer. Sign Here ▶ Signature of taxpayer ▶ Title ▶ Date For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. XxNo. 00000X Xxxx 0000 10241T Form 8655 (Xxx. Rev. 8-2014) STATE OF SOUTH CAROLINA SOUTH CAROLINA DEPARTMENT OF EMPLOYMENT & WORKFORCE 0000 XXXXXXX XXXXXX ~ XXXX XXXXXX XXX 000 XXXXXXXXForm 8655 (Rev. 8-2014) Page 2 General Instructions Purpose of Form Use Form 8655 to authorize a reporting agent to: • Sign and file certain returns. Reporting agents must file returns electronically except as provided under Rev. Proc. 2012-32. You can find Rev. Proc. 2012-32 on page 267 of Internal Revenue Bulletin 2012-34 at xxx.xxx.xxx/xxx/xxx-xxxx/xxx00-00.xxx; • Make deposits and payments for certain returns; • Receive duplicate copies of tax information, XX 00000 ELECTRONIC FUNDS TRANSFER AGREEMENT SCDEW Account # FID # Account Name notices, and Address This other written and/ or electronic communication regarding any authority granted; and • Provide IRS with information to aid in penalty relief determinations related to the authority granted on Form 8655. Note. An authorization does not relieve the taxpayer of the responsibility (or from liability for failing) to ensure that all tax returns are filed timely and that all federal tax deposits (FTDs) and federal tax payments (FTPs) are made timely. See section 5.05 of Rev. Proc. 2012-32. Employers who enroll in the Electronic Federal Tax Payment System (EFTPS) can view EFTPS deposits and payments made on their behalf under their employer identification number (EIN). Authority Granted Once Form 8655 is an agreement between signed, any authority granted is effective beginning with the South Carolina Department period indicated on lines 15 or 16 and continues indefinitely unless revoked by the taxpayer or reporting agent. A new authorization must be submitted to the Service for any increase or decrease in the authority of Employment & Workforcea reporting agent to act for its client. The preceding authorization remains in effect except as modified by the new one. No authorization or authority is granted for periods prior to the period(s) indicated on Form 8655. Where authority is granted for any form, it is also effective for related forms such as the corresponding non-English language form, amended return, (hereinafter SCDEWForm 941-X, 941-X(PR), and ( “the Employer”943-X, 944-X(PR), entered into 945-X, or CT-1X), or payment voucher. In addition to the returns shown on this lines 15 and 16, Form 8655 can be used to provide authorization for Form 944-SP using the day of entry spaces for Form 944. The SCDEW form also can be used to authorize a reporting agent to make deposits and payments for other returns in the Employer agree Form 1120 series, such as follows:Form 1120-C, using the entry space for Form 1120 on line 16. Disclosure authority granted on line 17a is effective on the date Form 8655 is signed by the taxpayer. Any authority granted on Form 8655 does not revoke and has no effect on any authority granted on Forms 2848 or 8821, or any third-party designee checkbox authority. Where To File Send Form 8655 to: Internal Revenue Service Accounts Management Service Center MS 6748 RAF Team 1973 North Xxxxx Xxxxx Blvd. Ogden, UT 84404 You can fax Form 8655 to the IRS. The number is 000-000-0000. Additional Information Additional information concerning reporting agent authorizations may be found in: • Pub. 1474, Technical Specifications Guide for Reporting Agent Authorization and Federal Tax Depositors. • Rev. Proc. 2012-32.

Disclosure Authorization. 18 a The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Form W-2 series information returns. This authority is effective for calendar year forms beginning . b The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Form 1099 series information returns. This authority is effective for calendar year forms beginning . c The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS notices relating to the Forms 3921 and 3922. This authority is effective for calendar year forms beginning . State or Local Authorization (Caution: See Authorization Agreement) 19 Check here to authorize the reporting agent to sign and file state or local returns related to the authorization granted on line 15 and/or line 16 ✔ Authorization Agreement I understand that this agreement does not relieve me, as the taxpayer, of the responsibility to ensure that all tax returns are filed and that all deposits and payments are made and that I may enroll in the Electronic Federal Tax Payment System (EFTPS) to view deposits and payments made on my behalf. If line 15 is completed, the reporting agent named above is authorized to sign and file the return indicated, beginning with the quarter or year indicated. If any starting dates on line 16 are completed, the reporting agent named above is authorized to make deposits and payments beginning with the period indicated. Any authorization granted remains in effect until it is revoked by the taxpayer or reporting agent. I am authorizing the IRS to disclose otherwise confidential tax information to the reporting agent relating to the authority granted on line 15 and/or line 16, including disclosures required to process Form 8655. Disclosure authority is effective upon signature of taxpayer and IRS receipt of Form 8655. The authority granted on Form 8655 will not revoke any Power of Attorney (Form 2848) or Tax Information Authorization (Form 8821) in effect. I certify I have the authority to execute this form and authorize disclosure of otherwise confidential information on behalf of the taxpayer. Sign Here ▶ Signature of taxpayer ▶ Title ▶ Date For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. Xx. 00000X Xxxx 0000 (Xxx. 8-2014) STATE OF SOUTH CAROLINA SOUTH CAROLINA DEPARTMENT OF EMPLOYMENT & WORKFORCE 0000 XXXXXXX XXXXXX ~ XXXX XXXXXX XXX 000 XXXXXXXX, XX 00000 ELECTRONIC FUNDS TRANSFER AGREEMENT SCDEW Account # FID # Account Name and Address This is an agreement between the South Carolina Florida Department of Employment & Workforce, (hereinafter SCDEW), Revenue POWER OF ATTORNEY and ( “the Employer”), entered into on this the day Declaration of Representative See Instructions for additional information. The SCDEW and the Employer agree as follows:DR-835 R. 10/11 TC Rule 12-6.0015 Florida Administrative Code Effective 01/12 PART I - POWER OF ATTORNEY