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North Dakota Free Printable Form 500 - Authorization To Disclose Tax Information & Designation Of Representative for 2024 North Dakota Authorization to Disclose Tax Information & Designate a Representative

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Authorization to Disclose Tax Information & Designate a Representative
Form 500 - Authorization To Disclose Tax Information & Designation Of Representative

AUTHORIZATION TO DISCLOSE TAX INFORMATION & DESIGNATION OF REPRESENTATIVE OFFICE OF STATE TAX COMMISSIONER Form 500 SFN 28258 (4-2020) Taxpayer Information Name of Individual, Estate, Trust, Partnership, Corporation, LLP, or LLC Telephone Number Social Security Number or FEIN Number Name of Spouse, Fiduciary or Personal Representative (if applicable) Telephone Number Social Security Number or FEIN Number Mailing Address State City Email Address ZIP Code Fax Number Designated Individual or Firm Name of Individual (or Firm) Mailing Address Telephone Number City Social Security Number or FEIN Number State ZIP Code Fax Number Email Address Authorization or Revocation - Check the applicable box(es): • An authorization to disclose tax information or designation of representative on Form 500 does not apply to the routine mailing of tax forms, refund checks, original notices (e.g., Notice of Determination), or other original written communications, which are always mailed to the taxpayer. • Form 500 takes effect upon receipt by the Office of State Tax Commissioner and remains in effect until revoked by the taxpayer. A. Authorization To Disclose Tax Information. The Tax Commissioner is authorized to disclose confidential tax information on file with the Office of State Tax Commissioner to the above-designated individual or firm with respect to the following matters: Type of Tax Form Number Tax Year or Period Type of Tax Form Number Tax Year or Period B. Designation of Representative. The Tax Commissioner is notified that the above-designated individual or firm has been authorized to represent the above-named taxpayer(s) before the Office of State Tax Commissioner with respect to the following matters: Type of Tax Form Number Tax Year or Period Type of Tax Form Number Tax Year or Period This designation of representative also authorizes the Tax Commissioner to disclose confidential tax information on file with the Office of State Tax Commissioner to the representative. The representative is authorized to perform all acts that the taxpayer can perform except that only an individual admitted and licensed to practice law in North Dakota may sign a complaint, represent the taxpayer in a formal administrative review under North Dakota Century Code ch. 28-32, or represent the taxpayer in any court proceeding. C. Authorization To Disclose Tax Information Using Facsimile (Fax) or E-mail. The Tax Commissioner is authorized to use facsimile or e-mail, or both, to disclose confidential tax information on file with the Office of State Tax Commissioner to the above-designated individual or firm with respect to the above-identified matters. D. Revocation. The Tax Commissioner is notified that all authorizations previously made are revoked for ALL previously designated individuals or firms. To revoke authorizations for only a specified individual or firm, complete the designated individual or firm information section above. (If this box is checked, do not check Box A, Box B, or Box C.) Signature of Taxpayer(s) Signature Printed Name Date Spouse's Signature, if Applicable Printed Name of Spouse Date Privacy Act Notification. In compliance with the Privacy Act of 1974, disclosure of a social security number or Federal Employer Identification Number (FEIN) on this form is required under N.D.C.C. § 57-01-15, and will be used for tax reporting, identification, and administration of North Dakota tax laws. Disclosure is mandatory. Failure to provide the social security number or FEIN may delay or prevent the processing of this form. For Office Use Only Form 500 Instructions SFN 28258 (4-2020) General Instructions Form 500 may be used by a taxpayer to do one of the following:   Authorize the North Dakota Office of State Tax Commissioner to disclose the taxpayer’s confidential tax information to another individual or firm not otherwise entitled to the information. Designate another individual or firm to represent or act on behalf of the taxpayer before the Office of State Tax Commissioner, and to authorize the North Dakota Office of State Tax Commissioner to disclose the taxpayer’s confidential tax information to the designated representative or firm. Form 500 does not apply to the routine mailing of tax forms, refund checks, original notices (e.g., a Notice of Determination), or other original written communications, which are always mailed to the taxpayer. Unless Box C on Form 500 is checked to authorize the sending of confidential tax information by facsimile (fax) transmission or email, the Office of State Tax Commissioner will send confidential tax information authorized by Form 500 to the designated individual or firm only by letter or telephone. Changing a previously filed Form 500. To change a Form 500 previously filed with respect to a particular designated individual or firm, complete and file a new Form 500 for that designated individual or firm. The new Form 500 automatically revokes and replaces the previously filed Form(s) 500. Revoking a previously filed Form 500. To revoke a previously filed Form 500, see instructions to Box D under “Authorization or Revocation.” When Form 500 takes effect. Form 500 takes effect upon receipt by the Office of State Tax Commissioner and remains in effect until revoked by the taxpayer. Specific Instructions Taxpayer Information Enter the taxpayer’s name, social security number or federal employer identification number (FEIN), mailing address, and contact information. For a trust, enter the trust’s name and FEIN, and the name, mailing address, and contact information of the fiduciary. For an estate, enter the decedent’s name and social security number, and the name, mailing address, and contact information of the decedent’s personal representative or fiduciary. Designated Individual or Firm Enter the name, social security number or federal employer identification number (FEIN), mailing address, and contact information for the designated individual or firm. If designating more than one individual or firm, attach a statement listing each one. Note: Do not complete this section of the form if filing this form to revoke previously filed Forms 500 and the revocation is intended to apply to all previously designated individuals and firms. Authorization or Revocation For Box A and Box B, the authorization to disclose or the designation of representative can be limited to a certain tax type (e.g., individual income tax or sales tax), form number, or taxable year or period by entering that information in the spaces provided. If attaching a statement to identify additional designated individuals or firms, indicate the authority being given to each one by entering “Box A” or “Box B” (and “Box C” if desired) next to each one listed on the statement. Box A - Check this box to authorize the Office of State Tax Commissioner to disclose confidential tax information to the designated individual or firm. Box B - Check this box to designate an individual or firm to represent or act on behalf of the taxpayer before the Office of State Tax Commissioner, and to authorize the Office of State Tax Commissioner to disclose confidential tax information to the designated individual or firm. Box C - Check this box to authorize the Office of State Tax Commissioner to send confidential tax information to the designated individual or firm by facsimile (fax) transmission or email. Box D - Check this box to revoke all previously filed Forms 500. To limit the revocation to a specific designated individual or firm, identify that individual or firm by completing the “Designated Individual or Firm” section of the form. Otherwise, leave that section of the form blank to apply the revocation to all previously designated individuals and firms. If checking this box, do not check any of the other boxes (A, B, or C) on the form. Signature of Taxpayer(s) Partnership (all types). One of the general partners must sign. Corporation. An officer having authority to bind the corporation must sign. Limited liability company. A governor or manager must sign. Estate, trust, or any other situation where there is a fiduciary relationship. The personal representative, trustee, guardian, conservator, or other fiduciary must sign. Where to Send Form 500 Form 500 may be submitted to the North Dakota Office of State Tax Commissioner by fax, email, or regular mail. Fax or email Income & Withholding Taxes— Fax 701.328.1942 Email [email protected] Business Registration— Fax 701.328.0332 Email [email protected] General (other tax or purpose)— Fax 701.328.3700 Email [email protected] Regular mail Office of State Tax Commissioner 600 E. Boulevard Ave., Dept. 127 Bismarck, ND 58505-0599
Extracted from PDF file 2023-north-dakota-form-500.pdf, last modified April 2020

More about the North Dakota Form 500 Other TY 2023

We last updated the Authorization to Disclose Tax Information & Designate a Representative in February 2024, so this is the latest version of Form 500, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form 500 directly from TaxFormFinder. You can print other North Dakota tax forms here.


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Other North Dakota Other Forms:

TaxFormFinder has an additional 44 North Dakota income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form SFN 24777 Application For Senior Citizen Or Permanently And Totally Disabled Renter's Property Tax Refund
Form 24757 Application for Property Tax Homestead Credit for Senior Citizens and Disabled Persons
Form 307 North Dakota Transmittal Of Wage And Tax Statement
Form 24734 Application for Property Tax Exemption for New or Expanding Businesses
Form 24737 Application For Property Tax Exemption of a Farm Residence

Download all ND tax forms View all 45 North Dakota Income Tax Forms


Form Sources:

North Dakota usually releases forms for the current tax year between January and April. We last updated North Dakota Form 500 from the Office of State Tax Commissioner in February 2024.

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Historical Past-Year Versions of North Dakota Form 500

We have a total of three past-year versions of Form 500 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2023 Form 500

Form 500 - Authorization To Disclose Tax Information & Designation Of Representative

2022 Form 500

Form 500 - Authorization To Disclose Tax Information & Designation Of Representative

2021 Form 500

Form 500 - Authorization To Disclose Tax Information & Designation Of Representative


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