IRS Paid Preparer Tax Identification Number (PTIN) 
Form   (Rev. October 2024) W-12                           Application and Renewal                                                         OMB No. 1545-2190
Department of the Treasury  
Internal Revenue Service                    Go to www.irs.gov/FormW12 for instructions and the latest information.
1 Name and PTIN                 First name                                                       Middle name Last name
(Print in ink or 
Type)
                                Initial application            Renewal application                           (Enter PTIN: P                               )
2 Year of                       If you checked the “Initial application” box and are submitting this form between October 1 and December 31, 
Application/                    indicate below whether you want your PTIN to be valid for the current calendar year or the next calendar year.
Renewal
                                Current calendar year                                    Next calendar year
                                Prior year(s) (YYYY): If you are applying for a prior year(s), write each year(s) below. Use the following format. 
                                (YYYY) See line 2 instructions for additional guidance.
                                Prior year(s)
3 SSN and Date                  Provide your U.S. issued Social Security Number SSN                                          Provide your Date of Birth. 
of Birth                        (SSN). If you have an SSN, you are required to                                               Make sure to use the standard 
You must                        provide it.                                                                                  U.S. format (Month/Day/Year) 
                                                                                                                             (Example: “April 01, 1956" = 
provide your                                                                    If you do not have an SSN,                   04/01/1956)
SSN or check                    Failure to provide your SSN or check the N/A 
the N/A box                     box will result in your PTIN application being  then check the N/A box.
                                rejected.                                              N/A
4 Personal                      Street address. Use a P.O. box number only if the post office does not deliver mail to your street address.
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 
Mailing                         different, enter it below.
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                  International business phone number 
                                                               EXT.             +
b Business                      Are you self-employed or an owner, partner, or officer of a tax return preparation business?              Yes              No
Identification                  If “Yes,” then complete this line. If “No,” go to line 6.
                                Enter the business name.

                                Your CAF Number                EIN                                           EFIN

                                Website address (optional)

For Privacy Act and Paperwork Reduction Act Notice, see instructions.                                        Cat. No. 55469F      Form W-12 (Rev. 10-2024)
                                                                                                             For Internal Use Only

                                                                                                             PID:

                                                                                                             CS:

                                                                                                             Date & Int:

                                                                                                             LTR:

Form W-12 (Rev. 10-2024)                                                                                                            Page 2
6 Email Address          Enter the email address that should be used to contact you. Provide an email address you have access to at 
                         ALL times.

7 Past Felony            Have you been convicted of a felony in the past 10 years?    You must check a box             Yes
Convictions                                                                                                            No
If “Yes,” you            If “Yes,” list the date and the type of felony conviction(s).
must provide an 
explanation. 
 
If this line is 
left blank, your 
form will not 
be processed

8 Address of             Enter the address used on your last individual U.S. federal tax return you filed.
Your 
Last U.S. 
Individual  
Income Tax               Check here if you have never filed a U.S. federal tax return or do not have a U.S. federal tax filing 
Return Filed             requirement. If this is an initial application, See line 8 instructions for documents that must be submitted 
                         with this form.
9 Filing Status          Single                            Head of Household
and Tax Year 
on Last U.S.             Married filing jointly            Qualifying widow(er) with dependent child
Individual 
Income Tax               Married filing separately         Tax Year (YYYY) 
Return Filed
                         Note: If your last return was filed more than 4 years ago, see instructions.
10 Federal Tax           Are you current on both your individual and business federal taxes, including any corporate and employment 
Compliance               tax obligations? Note: If you have never filed a U.S. individual tax return because you are not required to do so, 
                         check the “Yes” box.                                         You must check a box             Yes
If this line is                                                                                                        No
left blank, your         If “No,” provide an explanation.
form will not 
be processed

11 Data Security         I am aware that paid tax return preparers are required by law to create and maintain a written information 
Responsibilities         security plan that provides data and system security protections for all taxpayer information.
                         See IRS Publication 5708 and 4557 for more information about your responsibilities.
                                                                                                            Form W-12 (Rev. 10-2024)

Form W-12 (Rev. 10-2024)                                                                                                        Page 3
12 Professional          Check all that apply. Note:  DO NOT check any professional credentials that are currently expired or 
   Credentials           retired. Enter state abbreviation and appropriate number(s). If the expiration date is left blank or incomplete, 
                         that professional credential will NOT 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
13 Fees                  The fee to obtain or renew a PTIN is $19.75 for 2025. Full payment must be included with your application, or it 
   The fee is an         will be rejected. You must submit a separate check or money order for each calendar year. Indicate the 
   application           calendar year you intend the payment for on each check or money order.  
   processing fee 
   and is                If your payment(s) is returned your PTIN will be placed in Suspended status. You are responsible for 
   nonrefundable.        submitting the proper payment(s) to ensure your PTIN remains valid. 
                         Make your check or money order payable to IRS Tax Pro PTIN Fee for the correct fee amount required based 
                         on the calendar year(s) you are registering or renewing your PTIN. Do not paper clip, staple, or otherwise attach 
                         the payment to Form W-12. See the PTIN payment fee schedule below.  
                         2025 PTIN fee: $19.75 
                         2024 - 2021 PTIN fee: $19.75 
                         No fee is due for years 2020 or prior.
            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.
Sign        CAUTION: If you're a foreign preparer that resides outside of the U.S. and you obtain a PTIN without a U. S. 
            issued (SSN), you are not authorized to prepare federal tax returns in the U.S. for compensation.
Here        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 
   PO Box 380638 
   San Antonio, TX 78268
Note: Allow 6 weeks for processing of PTIN applications. For additional information, refer to the separate Instructions for Form W-12. 
If your application is incomplete and you do not supply the required information upon request, the IRS will be unable to process your 
application.
For Internal Use Only                                                                                          Form W-12 (Rev. 10-2024)