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NYC DEPARTMENT OF FINANCE AUDITl DIVISION
AGREEMENT TO AUTHORIZE ELECTRONIC
TRANSMITTAL OF TAX INFORMATION
Name of Taxpayer: __________________________________________ Type(s) of Tax: __________________________________
FIRSTNAME NAME LAST
Taxpayer’s NYC Admin. Code,
E-mail Address: ____________________________________________ Title 11, Chapter(s)_______________________________
Taxpayer’s Taxpayer’s
Phone Number:(________) _________________________(Fax Number: ________ )_____________________________
Name of Representative’s
Representative: ____________________________________________ E-mail Address: _________________________________
FIRSTNAME NAME LAST
Representative’s Representative’s
Phone Number: (________) _________________________(Fax Number: ________ ) ____________________________
Effective Date of Agreement: ________EndMONTH-________________Date of- Agreement:DAY ________________________YEAR - - MONTH DAY YEAR
The Taxpayer hereby authorizes the New York City Department of Finance (“DOF”) to transmit tax secret information pertaining to
the Taxpayer with the Taxpayer or the Taxpayer’s Representative using e-mail, web sites, or other internet-based service (here-
inafter referred to as “the electronic transmittal of information").
DOF is agreeing to the electronic transmittal of information solely for the convenience of the Taxpayer or the Taxpayer's Represen-
tative. The tax secret information that will be transmitted in such manner may include the Taxpayer’s tax returns or information con-
tained in Taxpayer’s tax returns. Applicable provisions in the New York City Administrative Code prohibit the disclosure by DOF of
tax secret information.
DOF has written security procedures relating to transmitting information with members of the public using e-mail, web sites, or other
internet-based service, of which the Taxpayer and Taxpayer’s Representative may have a copy upon request. DOF does not repre-
sent or promise that these procedures are adequate to preserve the secrecy of tax secret information transmitted in such manner.
The Taxpayer and the Taxpayer’s Representative hereby release The City of New York (“City”) from any and all liability, and the Tax-
payer agrees to indemnify and hold the City harmless from any damage, arising out of the electronic transmittal of information.
CERTIFICATION
Signature of Taxpayer: ____________________________________________ MONTH-________________- DAY YEAR Dated: ________
Signature of Taxpayer’s
Representative: _________________________________________________ MONTH-________________- DAY YEAR Dated: ________
Note: If the Taxpayer or the Taxpayer’s Representative is not an individual, then the following signature format should be used:
Signature of Taxpayer (or Taxpayer’s Representative): ______________________________________
By: _____________________________________________ Title: ___________________________________________
PRINTFIRSTANDLASTNAMEOFSIGNER
Auth-0505 Rev. 11.19.2020
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