Print Form
            AUTHORIZATION FOR RELEASE OF TAX INFORMATION
                                                                                                                   Clear Form
                                           Excise Tax Administration 
                                                Ledbetter Building  
                                                    Room 1340 
                                                PO Box 8092 
                                           Little Rock, AR  72203-8092 
                                   Telephone: (501) 682-7113      Fax: (501) 682-7667

            The information will not be released until the original signed document is received. 
        If a subsidiary of a parent corporation filing a consolidated return with Arkansas, give the name of the parent and  
       parent federal employer identification number (FEIN).  If the business is a Sole Proprietorship, enter the social security  
                              number (SSN) of the owner, in addition to the FEIN of the business.

      Ownership Type:          Corporation        Sub-S                                Partnership               Sole Proprietorship

FEIN:                                                                          OR    Social Security Number:

Company Name

Address

City                                                                           State                        Zip

Do you have employees in Arkansas?       YES                                     NO

                                       AUTHORIZATION FOR RELEASE

The taxpayer indicated above hereby authorizes the Arkansas Department of Finance and Administration to release information 
 to the following individual:

Name

Address

City                                                                           State                        Zip

Phone                                                                          Email

      Print Name of Taxpayer and Title; owner, president, vice president, etc.       Signature of Taxpayer 

Subscribed and Sworn to before me this       day of                                                         ,  20 .

            ( Seal )               Notary Public

                                                                                     Authorization for Release of Tax Form ET007 Revised 12/10/2021