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OMB No. 1513-0001 (05/31/2017)
DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
TAX INFORMATION AUTHORIZATION
(PURSUANT TO TITLE 26 OF THE UNITED STATES CODE AND THE FEDERAL ALCOHOL ADMINISTRATION ACT)
IMPORTANT - Please read nstructions i efore b ompleting c his t ormf .
(Prepare in duplicate)
PART I - AUTHORIZATION
1. PRINCIPAL 2. ADDRESS (Number, Street, City, State, ZIP Code)

3. BUSINESS IN WHICH ENGAGED

4. NAME OF REPRESENTATIVE (Attorney, Certified Public 5. ADDRESS (Number, Street, City, State, ZIP Code)
Accountant, or Agent)

6. THE ABOVE-NAMED REPRESENTATIVE IS HEREBY AUTHORIZED TO: (See Instruction 3)
a. Receive from, or inspect in, any office of the Director, National Revenue Center, and/or the Administrator, Alcohol and Tobacco
Tax and Trade Bureau, any confidential information on behalf of the principal.
b. Receive from, or inspect in, such office(s) confidential information with respect to:

.
Check applicable box(es)
c. Receive the original of any ruling (or correspondence in connection therewith) on behalf of the principal.

d. Receive copies of notices and other written communications addressed to the principal involving confidential tax matters.

7. THE SIGNATURE OF THE REPRESENTATIVE HEREBY AUTHORIZED TO RECEIVE CONFIDENTIAL INFORMATION

8. SIGNATURE OF OR FOR PRINCIPAL(S) (If a corporate officer, partner, or fiduciary signs below on behalf of the principal, the following statement
of authority applies)

I certify that I have the authority to execute this Tax Information Authorization on behalf of the principal.

SIGNATURE TITLE (If applicable) DATE CORPORATE
SEAL
(If applicable)
SIGNATURE TITLE (If applicable) DATE

SIGNATURE TITLE (If applicable) DATE

PART II - DECLARATION BY ATTORNEY OR CERTIFIED PUBLIC ACCOUNTANT (See Instruction 5)
9. I declare that I am not currently under suspension or disbarment from practice before the Alcohol and Tobacco Tax and Trade Bureau; that

a. I am a member in good standing of the bar of the highest court of .

b. I am qualified to practice as a certified public accountant in

and ;that I am authorized to represent .

SIGNATURE DATE
TTB F 5000.19 (02/2008)(12/2009)

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INSTRUCTIONS
1. 26 CFR Part 601, Subpart E, requires the filing of a Tax Informa- 4. Item 8: TTB F 5000.19 must be signed by the principal(s) as
tion Authorization for a representative to obtain, on behalf of the follows: (a) If an individual, by such individual. (b) If a husband
principal, information of a confidential nature as described in the and wife, by each of them, unless one spouse authorized the
regulations, unless a power of attorney is on file. TTB F 5000.19 other in writing to sign for both. In such case, the authorization
need not be filed if Power of Attorney, TTB F 5000.8, or a copy should accompany TTB F 5000.19. (c) If a partnership, either by
thereof, is on file in the office from which such confidential infor- all members or in the name of the partnership by one of the
mation will be received by the representative. partners authorized to act. In the latter case, unless the
authorization is provided under local law, it should accompany
2. TTB F 5000.19 must be filed in duplicate, with the Director, TTB F 5000.19. (d) If an estate, by the executor or administrator.
National Revenue Center. A copy of the Tax Information (e) If a corporation or an association, by an officer having
Authorization must also be filed with each office of TTB in which authority to bind the entity, who must certify that he has such
the attorney or agent is to represent the principal. If the authority. The Alcohol and Tobacco Tax and Trade Bureau does
authorization is applicable to more than one establishment or not require the affixing of a corporate seal. Space for affixing a
business, an additional copy for each must be submitted. Copies corporate seal is provided as conveniencea for a corporation
reproduced by photographic processes need not be certified as required by charter, or by the law of the jurisdiction in which it is
true and correct copies of the original; copies reproduced by incorporated, to affix its corporate seal in the execution of
other methods will be acceptable if their authenticity is certified instruments.
(a) by an attorney, certified public accountant, or agent; or (b) by
a notary public or other official, who will state that he has 5. Item 9: Qualified attorneys or certified public accountants who,
personally compared the copy with the original and finds it to be in addition to receiving tax information, will represent the principal
true and correct. in conference may complete the declaration in Part II. This
declaration, if completed, satisfies the requirement (26 CFR
3. Item 6: 26 CFR Part 601, Subpart E, requires that a Tax 601.521) to submit evidence of recognition to practice.
Information Authorization clearly express the scope of the
authority of the representative. If more than one person is 6. Revocation by the principal of the authority of an attorney,
authorized to represent he tprincipal, the representative who is certified public accountant, or agent to represent him/her must not
to receive notices and other written communications should be be effective before written notice has been given to the Director,
designated. The original of a ruling will be addressed to a National Revenue Center or Administrator, Alcohol and Tobacco
representative only if the Tax Information Authorization (or P ower Tax and Trade Bureau, as appropriate, that the authority of
of A ttorney) contains a statement to that effect. Therefore, the such representative has been revoked.
information covered by Item 6(c) and Item 6(d) will not be given
to the representative unless specifically authorized by a check 7. The rules governing the recognition of attorneys, certified public
mark in the applicable box. Authority in Item 6(d) should be accountants, and agents representing clients before the Alcohol
extended to one representative only, whether by TTB F 5000.8 or and Tobacco Tax and Trade Bureau are contained in Treasury
TTB F 5000.19. Department Circular No. 230, as amended (31 CFR Part 8), and
in the Statement of Procedural Rules (26 CFR Part 601 or those
regulations as recodified in 27 CFR Part 71 and 27 CFR 70.419).
Representatives must comply with such rules, as applicable, and
with all pertinent statutes.

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. This information collection documents the taxpayer's authorization granting a
specific individual to examine specified tax information. TTB uses the information to ensure that individuals other than the taxpayer have been properly
authorized to examine tax information which is confidential under Federal law. The information requested is voluntary.

The estimated average burden associated with this collection of information is 1 hour per respondent or recordkeeper, depending on individual circum-
stances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports
Management Officer, Regulations and Ruling Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, D.C. 20220.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current, valid OMB
control number.

TTB F 5000.19 ( /2009)

PDF file checksum: 3280806643

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