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Federal Free Printable Form W-12 (Rev. October 2017) for 2019 Federal IRS Paid Preparer Tax Identification Number (PTIN) Application and Renewal

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IRS Paid Preparer Tax Identification Number (PTIN) Application and Renewal
Form W-12 (Rev. October 2017)

W-12 IRS Paid Preparer Tax Identification Number (PTIN) Application and Renewal Form (Rev. October 2017) Department of the Treasury Internal Revenue Service ▶ Go OMB No. 1545-2190 to www.irs.gov/FormW12 for instructions and the latest information. 1 Name and PTIN First name (Print in ink or Type) Middle name Last name Initial application Renewal application 2 Year of Application/ Renewal (Enter PTIN: P ) If you checked the “Initial application” box and are submitting this form between October 1 and December 31, indicate below whether you want your PTIN to be valid for the current calendar year or the next calendar year. Current calendar year Next calendar year Prior year(s) (YYYY): Check box(es) below for the prior year(s) you are renewing your PTIN. See line 2 instructions for additional guidance. 2015 2016 Other prior year(s) SSN 3 SSN and Date of Birth - 2017 Date of birth (MM/DD/YYYY) - / / Street address. Use a P.O. box number only if the post office does not deliver mail to your street address. 4 Personal Mailing Address and Phone Number City or town, state or province, country, and ZIP or foreign postal code. Do not abbreviate name of country. Phone Number ( ) - 5a Business Business address Check here if your business address is the same as your personal mailing address. If different, enter it below. Mailing Address and Phone Number City or town, state or province, country, and ZIP or foreign postal code. Do not abbreviate name of country. Domestic business phone number ( b Business Identification ) - International business phone number EXT. + Are you self-employed or an owner, partner, or officer of a tax return preparation business? If “Yes,” then complete this line. If “No,” go to line 6. Enter the business name. Your CAF Number EIN Yes No EFIN - Website address (optional) 6 Email Address Enter the email address that should be used to contact you. For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. No. 55469F Form W-12 (Rev. 10-2017) For Internal Use Only F: E: A: Page 2 Form W-12 (Rev. 10-2017) 7 Past Felony Have you been convicted of a felony in the past 10 years? Convictions You must check a box. If “Yes,” If “Yes,” list the date and the type of felony conviction(s). you must provide an explanation. Yes No If this is your initial application for a PTIN, continue to line 8. If you are renewing your PTIN, go to line 10. Enter the address used on your last U.S. individual income tax return you filed. 8 Address of Your Last U.S. Individual Income Tax Check here if you have never filed a U.S. income tax return or do not have a U.S. income tax filing Return Filed requirement. See line 8 instructions for documents that must be submitted with this form and continue to line 10. 9 Filing Status and Tax Year on Last U.S. Individual Income Tax Return Filed Single Head of Household Married filing jointly Qualifying widow(er) with dependent child Married filing separately Tax Year (YYYY) Note: If your last return was filed more than 4 years ago, see instructions. 10 Federal Tax Compliance Are you current on both your individual and business federal taxes, including any corporate and employment tax obligations? Note: If you have never filed a U.S. individual income tax return because you are not required to do so, check the “Yes” box. Yes No If “No,” provide an explanation. Form W-12 (Rev. 10-2017) Page 3 Form W-12 (Rev. 10-2017) 11 Professional Credentials Check all that apply. Note: DO NOT check any professional credentials that are currently expired or retired. Enter state abbreviation and appropriate number(s). If the expiration date is left blank or incomplete, then NO professional credential will be added when the application is processed. Attorney—Licensed in which jurisdiction(s): Number(s): Expiration Date(s): Certified Public Accountant (CPA)— Licensed in which jurisdiction(s): Number(s): Expiration Date(s): Enrolled Agent (EA) Number(s): Expiration Date(s): Enrolled Actuary Number(s): Expiration Date(s): Enrolled Retirement Plan Agent (ERPA) Number(s): Expiration Date(s): State Regulated Tax Return Preparer —Licensed in which jurisdiction(s): Number(s): Expiration Date(s): Certifying Acceptance Agent (CAA) Number: None ▲ Sign Here Under penalties of perjury, I declare that I have examined this application and to the best of my knowledge and belief, it is true, correct, and complete. I understand any false or misleading information may result in criminal penalties and/or the denial or termination of a PTIN. Your signature (Please use blue or black ink) Date (MM/DD/YYYY) / / How To File Online. Go to the webpage www.irs.gov/ptin for information. Follow the instructions to submit Form W-12. If you submit your application online, your PTIN generally will be provided to you immediately after you complete the application. By mail. Complete Form W-12. Send the form to: IRS Tax Professional PTIN Processing Center 1605 George Dieter PMB 678 El Paso, TX 79936 Note: Allow 4 to 6 weeks for processing of PTIN applications. For additional information, refer to the separate Instructions for Form W-12. For Internal Use Only Form W-12 (Rev. 10-2017)
Extracted from PDF file 2018-federal-form-w-12.pdf, last modified October 2017

More about the Federal Form W-12 Other TY 2018

We last updated the IRS Paid Preparer Tax Identification Number (PTIN) Application and Renewal in February 2019, so this is the latest version of Form W-12, fully updated for tax year 2018. You can download or print current or past-year PDFs of Form W-12 directly from TaxFormFinder. You can print other Federal tax forms here.

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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form W-12 from the Internal Revenue Service in February 2019.

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Historical Past-Year Versions of Federal Form W-12

We have a total of eight past-year versions of Form W-12 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2018 Form W-12

Form W-12 (Rev. October 2017)

2017 Form W-12

Form W-12 (Rev. October 2017)

2016 Form W-12

Form W-12 (Revised October 2015)

IRS Paid Preparer Tax Identification Number (PTIN) Application and Renewal 2015 Form W-12

Form W-12 (Revised October 2015)

IRS Paid Preparer Tax Identification Number (PTIN) Application and Renewal 2014 Form W-12

Form W-12 (Revised October 2014)

IRS Paid Preparer Tax Identification Number (PTIN) Application and Renewal 2013 Form W-12

Form W-12 (Revised January 2013)

IRS Paid Preparer Tax Identification Number (PTIN) Application and Renewal 2012 Form W-12

Form W-12 (Revised September 2012)

IRS Paid Preparer Tax Identification Number (PTIN) Application and Renewal 2011 Form W-12

Form W-12 (Revised November 2011)


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