OMB No. 1545-1165 
                                                Tax Information Authorization                                                           For IRS Use Only 
Form  8821                    ▶ Go to www.irs.gov/Form8821 for instructions and the latest information.                            Received by: 
(Rev. February 2020)             ▶ Don’t sign this form unless all applicable lines have been completed.                           Name 
Department of the Treasury                    ▶ Don’t use Form 8821 to request copies of your tax returns                          Telephone
                                                                                                                                   Function
Internal Revenue Service                           or to authorize someone to represent you.                                       Date
1  Taxpayer information. Taxpayer must sign and date this form on line 7. 
Taxpayer name and address                                                        Taxpayer identification number(s)

                                                                                 Daytime telephone number  Plan number (if applicable) 

2  Appointee. If you wish to name more than one appointee, attach a list to this form. Check here if a list of additional 
  appointees is attached        ▶
Name and address                                                          CAF No. 
                                                                          PTIN 
                                                                          Telephone No. 
                                                                          Fax No. 
                                                                          Check if new: Address                Telephone No.                    Fax No. 
3  Tax Information.        Appointee is authorized to inspect and/or receive confidential tax information forthe    type of tax, forms, 
      periods, and specific matters you list below. See the line 3 instructions. 
        By checking here, I authorize access to my IRS records via an Intermediate Service Provider.
                     (a)                                (b)                          (c)                                                (d) 
 Type of Tax Information (Income,               Tax Form Number                  Year(s) or Period(s)                 Specific Tax Matters
Employment, Payroll, Excise, Estate, Gift,      (1040, 941, 720, etc.)
Civil Penalty, Sec. 4980H Payments, etc.)  

4  Specific use not recorded on Centralized Authorization File (CAF).            If the tax information authorization is for a specific 
      use not recorded on CAF, check this box. See the instructions. If you check this box, skip lines 5 and 6  .                  .   .    .   . . ▶

5 Disclosure of tax information (you must check a box on line 5a or 5b unless the box on line 4 is checked): 
a If you want copies of tax information, notices, and other written communications sent to the appointee on an ongoing 
      basis, check this box . .      .      . . .  .  . .    . . .    . . .  .   . . .    .   . .          . . .  . . .            .   .    .   . . ▶
      Note: Appointees will no longer receive forms, publications, and other related materials with the notices.
b If you don’t want any copies of notices or communications sent to your appointee, check this box  .               . .            .   .    .   . . ▶

6  Retention/revocation of prior tax information authorizations. If the line 4 box is checked, skip this line. If the line 4 box 
      isn’t checked, the IRS will automatically revoke all prior Tax Information Authorizations on file unless you check the line 6 
      box and attach a copy of the Tax Information Authorization(s) that you want to retain     .          . . .  . . .            .   .    .   . . ▶
      To revoke a prior tax information authorization(s) without submitting a new authorization, see the line 6 instructions.

7  Signature of taxpayer. If signed by a corporate officer, partner, guardian, partnership representative (or designated 
      individual, if applicable), executor, receiver, administrator, trustee, or party other than the taxpayer, I certify that I have the 
      legal authority to execute this form with respect to the tax matters and tax periods shown on line 3 above.

      ▶ IF NOT COMPLETE, SIGNED, AND DATED, THIS TAX INFORMATION AUTHORIZATION WILL BE RETURNED. 

      ▶ DON’T SIGN THIS FORM IF IT IS BLANK OR INCOMPLETE. 

      Signature                                                                                              Date 

      Print Name                                                                                             Title (if applicable) 

For Privacy Act and Paperwork Reduction Act Notice, see the instructions.            Cat. No. 11596P                               Form 8821 (Rev. 2-2020)