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ACD-31102 New Mexico Taxation and Revenue Department
Rev 08/19/2021
Tax Information Authorization
Tax Disclosure
PLEASE TYPE OR PRINT IN BLACK INK
This form will expire one, two, or three years (as selected below) from the date that this Tax Information Authorization Tax Disclosure form
has been signed by the authorizing individual listed below. If your authorized representative changes before that, notify the Department.
Section I: Taxpayer Information
*Required Fields (If the required fields are not complete this form is VOID and the taxpayer(s) information will not be shared.)
Names(s)* Tax Identification Number(s)* Reporting Period(s)*
SSN: _ _ _ -_ _ -_ _ _ _ Tax Year(s): _____________
DBA Name(s)(if appliable) Spouse SSN: _ _ _ -_ _- _ _ _ _ Starting Period: ___________
Ending Period:
FEIN: _ _ - _ _ _ _ _ _ _ ____________
Mailing Address* (If the address is new or changed, mark this box q ) Effective for:
NMBTIN:_ _-_ _ _ _ _ _- _ _- _ q 1 Year q 2 Year q3 Year
City* State* Zip Code* Tax Program(s)*
q All State Taxes q All Business Taxes
Telephone Number q Personal Income Tax q Gross Receipts Tax¹
( ) q Fiduciary Income Tax q Compensating Tax
E-mail Address q Corporate Income Tax q Withholding Tax²
q Oil and Gas Taxes q Other: ____________________
¹Includes: Gross Receipts, Governmental Gross
Fax Number q Other: __________________ Receipts, Interstate Telecommunications Gross
Receipts, and Lease Vehicle Gross Receipts Tax
²Includes Wage and Non-wage Withholding Tax
Section II: Authorized Representative(s) Information
Individual Representative's Name* Additional Individual Representative's Name
Mailing Address* Mailing Address
City* State* Zip Code* City State Zip Code
Telephone Number* Telephone Number
( ) ( )
E-mail Address E-mail Address
Fax Number Fax Number
Authorizing Signature(s)
By signing below, I acknowledge that the authorized individual representative(s) listed above have the authority to receive Federal and
State confidential information on behalf of the taxpayer listed above in tax matters related to this form per NMSA 1978, § 7-1-8 and 26
U.S.C. § 6103.
q By checking this box, I (the taxpayer) am authorizing the New Mexico Taxation and Revenue Department Secretary or Secretary’s
delegate, to use facsimile, e-mail, or both. I understand that the fax numbers and e-mail addresses above will be used when providing
confidential information.
Printed Name* Printed Name
Title Title
Signature* Date* Signature Date
• For taxpayers authorizing the Department to disclose return information for a married filing joint personal income tax return, both taxpayers must sign
this form.
• For a business or estate this form must be signed by a corporate officer, partner, or fiduciary who has been previously identified as such to the Depart-
ment.
If you need assistance completing this form contact the call center at 1-866-285-2996. This form can be submitted at any of the district offices listed below, by
mail, or by fax.:
Santa Fe Albuquerque Las Cruces Farmington Roswell
1200 South St Francis Dr 10500 Copper Pointe Ave 2540 El Paseo, Bldg. #2 3501 E. Main St., Suite N 400 N Pennsylvania Ave
Santa Fe, NM 87502-5374 Albuquerque, NM 87198-8485 Las Cruces, NM 88004-0607 Farmington, NM 87499-0479 Suite 200
Roswell, NM 88202-1557
Mail : Taxation and Revenue Department, P.O. Box 8485, Albuquerque, NM 87198-8485
Fax: 1-505-841-6471 Email: Business.Reg@state.nm.us
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