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NEW YORK CITY DEPARTMENT OF FINANCE
NYC
Signature Authorization for
2022
579-UBTI E-Filed Unincorporated Business Tax Return for Individuals
ELECTRONIC RETURN ORIGINATORS (ERO): DO NOT MAIL THIS FORM TO THE DEPARTMENT OF FINANCE. KEEP THIS FOR YOUR RECORDS.
FIRST NAME AND INITIAL : LAST NAME SOCIAL SECURITY NUMBER
EMAIL ADDRESS: TYPE OF n NYC-5UBTI (2023) n NYC-EXT
FORM:
n NYC-202 n NYC-202S
Financial Institution Information - must be included if electronic payment is authorized
AMOUNT OF AUTHORIZED DEBIT : FINANCIAL INSTITUTION ROUTING NUMBER : FINANCIAL INSTITUTION ACCOUNT NUMBER :
Part A — Declaration and authorization of Taxpayer for Forms NYC-202, NYC-202S, NYC-EXT or NYC-5UBTI
Under penalty of perjury, I declare that I am the taxpayer and that I have examined the information on its 2022 New York City electronically filed Unincorporated
Business Tax return, including any accompanying schedules, attachments and statements or other report, and to the best of my knowledge and belief, the electron-
ically filed document is true, correct and complete. The ERO has my consent to send the 2022 New York City electronically filed Unincorporated Business Tax
return or other report checked above to the New York City Department of Finance through the Internal Revenue Service. I authorize the ERO to enter my PIN
as my signature on the 2022 New York City electronically filed Unincorporated Business Tax return or other report, as indicated above or I will enter my PIN as
my signature on the document indicated above. If I am paying the New York City Unincorporated Business Tax owed by electronic funds withdrawal, I author-
ize the New York City Department of Finance and its designated financial agents to initiate an electronic funds withdrawal from the financial institution account
indicated on the Unincorporated Business Tax return or other report, and I authorize the financial institution to debit the amount from that account.
n I authorize ___________________________________________________ to enter my PIN :
ERO FIRM NAME
as my signature on the 2022 Unincorporated Business Tax return or other report, as indicated above
n As the taxpayer I will enter my PIN as my signature on the 2022 Unincorporated Business Tax return or other report, as indicated above.
_______________________________________________________ _____________________________________ ____________________
Signature of Taxpayer Official title Date
Part B — Declaration of electronic return originator (ERO) and paid preparer
Under penalty of perjury, I declare that the information contained in the above-named taxpayer’s 2022 New York City electronically filed unincorporated busi-
ness tax return or other report checked above is the information furnished to me by the taxpayer. If the taxpayer furnished me with a completed 2022 New
York City paper unincorporated business tax return or other report signed by a paid preparer, I declare that the information contained in the taxpayer’s 2022
New York City electronically filed unincorporated business tax return or report is identical to that contained in the paper return. If I am the paid preparer, under
penalty of perjury I declare that I have examined this 2022 New York City electronically filed unincorporated business tax return or other report, and, to the
best of my knowledge and belief, the return is true, correct, and complete. I have based this declaration on all information available to me.
ERO EFIN/PIN: Enter your six-digit EFIN followed by your five digit PIN:
_________________________________________ _____________________________________ ________________
ERO’s Signature Print Name Date
_________________________________________ _____________________________________ ________________
Paid Preparer’s Signature Print Name Date
PURPOSE - A completed Form NYC-579-UBTI provides documentation that an ERO has been authorized to electronically file the Unincorporated Business Tax return or other
report. The taxpayer may designate the ERO to electronically sign the return or other report by entering the taxpayerʼs personal identification number (PIN). The form also author-
izes payment of tax due on an electronically submitted return or report by an automatic clearing house (ACH) debit from a designated checking or savings account of the taxpayer.
You cannot revoke this authorization.
GENERAL INSTRUCTIONS
Part A - Part A must be completed by the taxpayer before the ERO transmits the electronically filed Form NYC-202 (Unincorporated Business Tax Return for Individ-
uals and Single Member LLC’s); NYC-202S (Unincorporated Business Tax Return for Individuals); NYC-EXT (Application for 6-Month Extension to File Busi-
ness Income Tax Return); or NYC-5UBTI (Declaration of Estimated Unincorporated Business Tax for Individuals, Estates and Trusts).
EROs/paid preparers must complete Part B prior to transmitting electronically filed unincorporated business tax returns or reports (Forms NYC-202, NYC-202S, NYC-
EXT or NYC-5UBTI). Both the paid preparer and the ERO are required to sign Part B. However, if an individual performs as both the paid preparer and the ERO, he
or she is only required to sign as the paid preparer. It is not necessary to include the ERO signature in this case.
Do not mail Form NYC-579-UBTI to the Department of Finance. The EROs/paid preparers must keep the completed Form NYC-579-UBTI for three years from
the due date of the return or report or the date the return or report was filed, whichever is later, and must present it to the Department of Finance upon request.
NYC-579-UBTI 2022
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