Minnesota Bank Authorization for Direct Debit

Bank Authorization for Direct Debit
BANK, Bank Authorization for Direct Deposit
Form BANK, Authorization for Direct Debit for

(year)

Note: Use this form only for tax years 2019 and earlier.

Complete if you are electronically filing your tax return (Form M1, M2, M3, M4, M4NP, M8, M11, or M11L), and you want to authorize a
transfer of funds from your account to pay tax owed as shown on your return. Do not complete if filing a paper return.
Your Name or Name of Entity		

Social Security or Minnesota Tax ID Number

Spouse’s Name, if Filing Joint (Or Partner if a Partnership)		

Spouse’s Social Security Number (If Filing Joint)

Street Address 	

City 		

State	

ZIP Code

Type of Account
Checking

Savings

Routing Number

Date Of Withdrawal

Account Number
Amount of Withdrawal

I authorize the Minnesota Department of Revenue to initiate debit entries to my account as indicated above. This authority will remain in effect until the department
has received written notification of its termination at least 30 days prior to the effective date.
Your Signature	

Spouse’s Signature (if filing joint)	

Date	

Daytime Phone

ERO: Attach Minnesota copies of all W-2, W-2G and 1099-R forms and any other form that shows Minnesota income tax withheld and keep with your records.

Do not mail Form BANK to the Minnesota Department of Revenue unless requested.

Form BANK Instructions
Complete Form BANK if you are electronically filing your Form M1, M2, M3, M4, M4NP, M8, M11 or M11L and you want to have your
taxes due automatically withdrawn (direct payment) from your checking or savings account.
The Bank Authorization for Direct Debit (BANK) complies with current ACH rules.
Note: Use this form only for tax years 2019 and earlier.

If you are the Taxpayer
The direct payment option is voluntary and applies only to the electronic return you are filing.
By signing Form BANK you are authorizing the Minnesota Department of Revenue to automatically withdraw the taxes due directly from
your checking or savings account.
You must sign and date this form. If you are filing a joint return, your spouse must also sign.
Your tax preparer is required to keep a signed Form BANK until the end of the calendar year in which your return was electronically filed.
If you are preparing your own return, keep Form BANK with your tax records.
Do not mail this form to the department.

If you are the Electronic Return Originator (ERO)
Currently, the IRS requires you to keep Forms W‑2, W-2G, and 1099, and other documents for three years. You should also keep with these
IRS records the signed, original Form BANK, Minnesota copies of all Forms W-2, W-2G, and 1099, and any other form that shows Minnesota
income tax withheld.
If you choose to discard Minnesota records earlier, the minimum length of time you must keep these documents on file is until the end of the
calendar year in which the return was filed electronically.
If we request copies of Forms BANK, W-2, W-2G, or 1099, you must provide the information within five working days.

Do not mail Form BANK unless we ask you to do so.