Disclosure                                                                                          Arizona Form 
 Authorization     Form                                                                                    285B   
Phone Numbers                                                      If Taxpayer is a consolidated or combined group of corporations, 
                                                                   Taxpayer must attach a federal Form 851 or a supplemental sheet, 
For information or help, call one of the numbers listed:           as applicable,  containing the names of each  member of the 
Phoenix                                (602) 255-3381              consolidated/combined  group  for  which the signator of  Form 
From area codes 520 and 928, toll-free (800) 352-4090              285B  is a  principal  corporate officer  and to which  this  Form 
Tax forms, instructions, and other tax information                 285B applies. 
If you need tax forms, instructions, and other tax information,    Foreign Address - 
go to the department’s website at www.azdor.gov.                   If the taxpayer has a foreign address, enter the information in 
                                                                   the  following order:  city,  province or state, and  country.  
Purpose of Form                                                    Follow the country’s practice for entering the postal code.  Do 
                                                                   not abbreviate the country name. 
Form 285B enables any  individual, sole proprietorship, 
corporation, group of consolidated/combined corporations,          For income tax purposes: 
partnership,  LLC,  estate, trust, governmental agency, or other    • Each individual signing this  form  must enter  his or her 
organization, association, or group thereof (“Taxpayer”) to           Social  Security  Number  (SSN)  or  Individual Tax 
designate a person (“Appointee”) to whom the Arizona                  Identification Number (ITIN). 
Department of Revenue can release confidential information,         • A corporation, partnership, LLC, trust or estate must enter 
pursuant to A.R.S. § 42-2003.                                         its employer identification number (EIN).   
The disclosure of such confidential information may be necessary   For withholding tax purposes: 
to fully discuss tax issues with, or respond to tax questions by   An individual, corporation, partnership,  LLC,  trust,  or estate 
such Appointee.   For more information or guidance for             must enter the EIN.   
completing this form, see General  Tax Procedure (GTP) 15-2, 
Procedure for Submitting an Authorization for Disclosure of        For transaction privilege tax (TPT) purposes: 
Confidential Information and Powers of Attorney.                   If the taxpayer  has only one license  that is covered by this 
                                                                   Form 285B, enter that specific TPT license number.   
Important Tips -  
                                                                   If the taxpayer has more than one license number, include a 
•   Review the instructions and GTP 15-2 before completing 
                                                                   separate sheet identifying the license number and location for 
    the form.  
                                                                   each license that is covered by this Form 285B.   
•   Inspect the  form and  verify  you  have entered all of the 
    required information.                                          NOTE:   If a taxpayer  wants all of its business locations 
•   Retain a copy for your files.                                  covered by this Form 285B, include the EIN of the business (or 
                                                                   the SSN  or ITIN  associated with the business if the business 
How to File                                                        does not have an EIN). 

If an  Arizona Department  of Revenue (ADOR) employee                                                        
                                                                   Section 2 - Appointee Information
requests that you submit this form, please send the completed 
form directly to the address that the employee provides, with      The Appointee must be an individual.  Enter the first and last 
attention to the employee.                                         name and current address of the person taxpayer is appointing to 
                                                                   be  to  receive  Taxpayer’s  confidential  information.   If  the 
Otherwise,  ADOR offers three convenient options to submit         Appointee  has a  foreign address, enter the information in  the 
your form.                                                         following order:  city, province or state, and country.  Follow the 
1.  Email the completed form to:  POA@azdor.gov.                   country’s practice for entering the postal code.  Do not abbreviate 
2.  Fax the completed form to:  (602) 716-6008.                    the country name. 
3.  Mail the original or photocopy of the completed form to:       Enter the ID number of the individual (Appointee).  This may 
    Arizona Department of Revenue                                  be an  SSN,  ITIN,  Certified Public Account  (CPA)  number, 
    ATTN:  Power of Attorney                                       State Bar  number,  Alternative Preparer  Tax Identification 
    PO Box 29086                                                   Number, or other government issued ID number that is unique 
    Phoenix, AZ 85038-9086                                         to the Appointee  (for example:  a passport or driver’s license 
                                                                   number).   If the taxpayer  wants to name  more than  one 
                                                                   Appointee, please attach an additional sheet that contains the 
 Line-by-Line      Instructions 
                                                                   required information for each Appointee. 
Section 1 - Taxpayer Information 
                                                                   NOTE:  The number used must be different for each individual 
Enter  Taxpayer’s name,  current address, and daytime telephone    Appointee  designated.  For identification purposes, the 
number on the lines provided.  If more space is needed, attach an  Appointee  will  be  required  to  provide  that  number  when 
additional page.                                                   contacting the Department. 
 

                                                                                                           Arizona Form 285B 
 
Section 3 - Tax Matters                                                 Partnerships (general or  •  Any general partner of the 
This form  can be used  for  more than one  tax  type.  This form       limited partnerships         partnership; designee of general 
authorizes disclosure of confidential information to the Appointee                                   partner. 
but does not  authorize the Appointee  to perform any  additional       Limited Liability         •  Member in a member-managed 
acts on behalf of a taxpayer.                                           Company (LLC) (if            LLC.  
1.  Please check applicable  box(es) for which Appointee is             taxation is at the entity •  Manager in a manager-managed 
                                                                                                     LLC  
  authorized to receive Taxpayer’s confidential information.            level) 
                                                                                                  •  Designee of member or 
  Check the box  marked  “Other”  for any of the  following             See above Individual if      manager. 
  taxes and be sure to indicate the tax type in the space under         where LLC elected to 
  the box.                                                              be treated as a 
  • Tobacco tax                                                         disregarded entity or 
  • Liquor tax                                                          where tax relates to 
  • Bingo tax                                                           flow through items on 
                                                                        individual return 
2.   Specify the tax year(s) or tax period(s).   
                                                                        Estates                    •
3. Check the box that properly describes the form of ownership                                       Personal representative 
  of the Taxpayer.  (See GTP 15-2 for guidance).                                                   • Any heir, next of kin, or 
                                                                                                     beneficiary, only if he has a 
Section 4 - No Revocation of Earlier                                                                 material interest that will be 
Authorization                                                                                        affected by the confidential 
This Disclosure Authorization Form does not revoke any prior                                         information. 
Power of Attorney or other authorization forms on file with             Trusts                     • Any trustee 
department. 
                                                                                                   • A beneficiary or grantor only if 
Section 5 – Signature of or for Taxpayer                                                             the beneficiary or grantor has a 
(table continued on next column)                                                                     material interest that will be 
                                                                                                     affected by the confidential 
                                 Who may sign an 
    Taxpayer                                                                                         information. 
                                   authorization 
                                                                        Government Entity          • Head of the entity or a member 
 Individual - Single           • Individual                                                          of the governing board of the 
 Individual - Joint            • Both sign same document for                                         entity, or any employee of the 
                                 the same representative.                                            entity who has been delegated 
                               • Each signs separate document                                        the authorization in writing by 
                                 for two representatives.                                            the head of the entity or the 
                                                                                                     governing board of the entity. 
 Sole Proprietorship           • The individual owner of 
 Business (Federal Form          business.                              Bankruptcy                 • Refer to court document 
 1040 Schedules C, E, F                                                 estate/receivership          appointing bankruptcy trustee to 
 income) This includes                                                                               ensure disclosure is authorized. 
 where there is no entity 
 or where entity is                                                    NOTE FOR CORPORATIONS:                 An Officer holding a 
                                                                       corporate title other than one of those listed, should check the 
 disregarded for income 
                                                                       box above the signature line in Section 5 to certify that they 
 tax purposes (e.g. 
 disregarded LLC)                                                      are a principal officer of the corporation.  For example; a Vice 
                                                                       President of Finance or an Assistant Treasurer is not listed 
 Corporations                  • A principal corporate officer         and therefore would be required to certify that the officer is a 
                                 (chief executive officer,             principal officer by checking the box in Section 5. 
 SEE NOTE FOR                    president, secretary, treasurer, 
 CORPORATIONS                    vice president of tax, chief          For  more information, see the department’s General  Tax 
 LOCATED AT THE                  financial officer, chief operating    Procedure, GTP 15-2,        Procedure for Submitting an 
 END OF THIS                     officer or chief tax officer or any   Authorization for Disclosure of Confidential Information and 
 TABLE                           other corporate officer who has       Powers of Attorney. 
                                 the authority to bind the taxpayer     
                                 on matters related to state taxes). 

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