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Authorization to Disclose Tax Return Information

Federal law requires this authorization before we can disclose tax return information for purposes other than preparing and filing your return. Complete the form below to generate a signed PDF for your records and for our files.

How it works

  • Takes about 2–3 minutes to complete.
  • Creates a signed PDF immediately after submission.
  • Download the PDF and a copy will be sent to Harden, Cummins, Moss & Miller, L.L.C. for secure recordkeeping.

Authorization to Disclose Tax Return Information

Federal law requires this consent form be provided to you. Unless authorized by law, we cannot disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return without your consent. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution.

You are not required to complete this form to engage our tax return preparation services. If we obtain your signature on this form by conditioning our tax return preparation services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature.

Name of party to disclose to:(Required)
(to whom the information is being disclosed to)
(to whom the information is being disclosed to)
(to whom the information is being disclosed to)
Address of party to disclose to:
(to whom the information is being disclosed to)
Authorization to Disclose Tax Return Information: By signing this consent, I authorize Harden, Cummins, Moss & Miller, L.L.C. to disclose my tax return information. Complete below: Name (First & Last) • Email • Duration of consent.
Taxpayer Name(Required)
Enter your first and last name as it appears on your tax return.
Examples: “One year”, “Six months”, or “Until [date]”.
Clear Signature
MM slash DD slash YYYY

If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at complaints@tigta.treas.gov.