DELAWARE Page 1
Authorization to Release Tax Information
FORM 8821DE
Completion and submission of this form authorizes the Delaware Division of Revenue to release confidential information of the Taxpayer(s)
named below to the authorized person(s) or organization named below for the tax type(s) specified below. This form does not give Power
of Attorney and does not grant the authorized person(s) or organization any powers of representation. Unauthorized disclosure of tax
information is a criminal offense.
Read the instructions below before completing this form. S o S l a i c ec F r o y t i r u ed E l a r e m o l p y n D I r e umb r e
Yo n r u am n r o e am e f o e y t i t n
Spouse’s name, if joint (or corporate officer, partner or fiduciary if a business)
Spouse’s Social Security number (if a joint return)
e r t S a t e d e r d s s
Print or Type
City State ZIP Code -
I authorize the following person or organization to inspect and/or receive private and non-public information in regard
to the tax types and periods provided below.
Name of person or organization to receive tax information Name of firm (if applicable)
e r t S a t e d e r d s s
City State ZIP Code -
or Organization
Authorized Person
Phon e Numb r e F a N x umb r e
The above person or organization is authorized to receive the following tax information (check all that apply):
Typ T f o e a x Ye P r o ) s ( r a o i r e ) s ( d
n I d i v i d u n I l a come from to
Corporate Income from to
P a o r h t - s s ug h R n r u t e from to
Gross Receipts from to
Withholding from to
Tax Information
Other (please specify): from to
The authorization to release tax information is not valid until it is signed and dated. It will expire 60 days after the information is released. By signing this form,
I hereby certify that the Delaware Division of Revenue is authorized to release any and all confidential information concerning the above mentioned release any
and all confidential information concerning the above mentioned Taxpayer under penalty of law. A copy of this form will be mailed to the individual(s) authorizing the release.
Your Signature Date Spouse’s Signature (if joint) Date
Print Name Print Spouse’s Name (if joint)
Print Title (if applicable) Phone
Sign Here
Phone
Mail to: Delaware Division of Revenue, 820 North French Street, Wilmington, DE 19801
Form 8821DE Instructions
Purpose of this form
You must complete, sign and return this form if you want to authorize a person ororganization to inspect and/or receive certain private or
nonpublic information concerning your state taxes. By completing and signing this form, you are authorizing the Division of Revenueto release
tax information to the person or organization you have indicated. Revenue will accept copies of the form,including those from a FAX machine.
This authorization will expire 60 days after the information is released to the person or organization you have indicated.
Your Signature
The authorization to release tax information is not valid until it is signed and dated. Your spouse must also sign if joint returns are listed.Your
signature at the bottom of this form authorizes the individual or organization you designate to only be able to inspect and/or receive confidential
tax information on your behalf.
Questions?
If you have questions on how to complete this form or to fax this form, call (302) 577-8200 for a staff contact who will provide you with a fax
number. You must include a Division of Revenue contact name on all faxed authorization forms.
(Revised 1 /120 61 )