BA: RS1 
                                                                                                               3/2020
                                    State of Alabama 
                                                                                                               RESET
                       Department of Revenue 
                                    Montgomery, Alabama 36132 
                                                        (www.revenue.alabama.gov)

               Agreement Extending Period of Limitation 

                       For Assessment or Refund 
               FOR INSTRUCTIONS SEE REVERSE SIDE • SIGN AND RETURN ALL COPIES
Taxpayer’s Name and Address:

                                                         SSN:   XXX-XX- 

                                                         Spouse’s SSN:  XXX-XX- 
                                                         (If applicable)
                                                         FEIN: 
                                                         (If applicable)
                                                         Taxable Period(s):

As provided in Code of Alabama 1975, the taxpayer and the Alabama Department of Revenue hereby consent 
and agree as follows: 

The amount of _____________________________ tax(es) / penalty / interest due from, or refund due to, the 
                                   (type of tax)
taxpayer under the provisions of the Code of Alabama 1975, for the tax period(s) indicated, may be 
assessed or claimed at any time on or before 

                                   ________________________________ , 20______ ; 

except that the Department may also enter an assessment of income or estate taxes at any time prior to 
the expiration of one year from the date the Department is notified or otherwise learns of a final determi-
nation by the Internal Revenue Service of the taxpayer’s liability for federal income or estate taxes for the 
concurrent period(s); and the taxpayer may file a claim for refund at any time prior to the expiration of one 
year from the date the federal changes become final. 

                                                For the Individual Taxpayer 

Signature of Taxpayer  
or Representative ____________________________________________________ Date ________________________ 

Spouse’s Signature ___________________________________________________ Date ________________________ 
(If applicable)
If you are an attorney or agent of the taxpayer(s), you may sign this consent provided the action is specifically 
authorized by a power of attorney. If the power of attorney was not previously filed with the Alabama 
Department of Revenue, please include it with this form. 

For the Corporate Taxpayer                               Alabama Department of Revenue 

_______________________________________________          By ____________________________________________ 
                   (Corporate name)                                              (Signature) 

_______________________________________________          _______________________________________________ 
               (Officer or Representative printed name)                          (Representative printed name) 

By _____________________________________________         Title ______________________________ Date__________ 
                       (Signature) 

Title _______________________________ Date__________

      Individual Instructions 
 
If this consent is executed with respect to a year for which a joint return of a husband and wife was filed, it must 
be signed by both spouses, except that one spouse may sign as the agent for the other. 
 
Sign and return all copies of this form. 
 
      Corporate Instructions 
                                          
Type or print the corporate name, followed by the signature and title of such officer or officers of the corpora-
tion as are empowered under the laws of the state in which the corporation is located to sign for the corpora-
tion. 
 
Sign and return all copies of this form.