Oklahoma Disclosure of Tax Information Authorization

Disclosure of Tax Information Authorization
Form A-100 Disclosure of Tax Information Authorization
Oklahoma Tax Commission

OTC Form

A-100

Disclosure of Tax Information Authorization

Revised 8-2023

Do not sign this form unless all applicable lines have been completed.

1.	Taxpayer Information. Taxpayer(s) must sign and date this form in Section 5.
Company or Individual Name(s) and Address

Social Security Number(s)

Employer Identification Number

Daytime Telephone Number
(	)

2.	Appointee. If you wish to name more than one appointee, check this box and attach a list to this form.
Name and Address

Telephone Number
(	)
Fax Number
(	)

3.	Tax Matters. The appointee is authorized to inspect and/or receive confidential tax information for the tax

matters listed below. For printed copies of returns, the appointee must complete and submit a Form 599 for income
tax returns or Form BT-199 for business tax returns. Payment of copy fees will be required upon submission.
(A)
Tax Type

(B)
Tax Form Number

(C)
Year(s) or Period(s)

(D)
Special Tax Matters

4.	Disclose Tax Information.
Pursuant to the provisions of 68 OS Sec. 205(C)(16) or (C)(23) of the Oklahoma Uniform Tax Procedure Code,
I request information relating to any liabilities, assessments, or warrants of the business identified above which
have not been filed or recorded, established, or become final and which relate specifically to my business activities to be released to persons indicated above in Section 2.
Check the appropriate box: (If a box is not selected the tax information authorization will not be processed.)
(A)	

Information is being requested for the prospective purchase of an existing business. 68 OS Sec. 205(C)(23).

(B)	

Information is being requested for waiver of confidentiality. 68 OS Sec. 205(C)(16).

5.	Signature of Taxpayer(s). See Instructions.
I attest that I have the authority to authorize the disclosure of any and all information in the files and records of the
Oklahoma Tax Commission pertaining to said business to the extent necessary.
If not signed and dated, this Tax Information Authorization will not be processed.

Taxpayer Signature	

Date

Title (if applicable) - Print Name
Mail To: Oklahoma Tax Commission, Oklahoma City, OK 73194
Questions Call: 405.521.3160

Taxpayer Signature	
Title (if applicable) - Print Name

Date

Form A-100
Page 2

Disclosure of Tax Information Authorization - General Instructions

Purpose of Form
Form A-100 authorizes any individual, corporation, firm, organization, or partnership you designate to inspect and/or receive your
confidential information of the Oklahoma Tax Commission (OTC) for the type of tax and the years or periods you list.
Form A-100 does not authorize your appointee to advocate your position with respect to the tax laws; to execute waivers, consents, or
closing agreements; or to otherwise represent you before the OTC. If you want to authorize an individual to represent you, use Power of
Attorney Form BT129.

When To File
Form A-100 must be received by the OTC within 30 days of the date it was signed and dated by the taxpayer.

Revocation of an Existing Tax Information Authorization
If you want to revoke an existing tax information authorization and do not want to name a new appointee, send a copy of the previously
executed tax information authorization to the OTC. The copy of the tax information authorization must have a current signature and date
under the original signature on line 5 with “REVOKE” written across the top of the form. If you do not have a copy of the tax information
authorization and you want to revoke, send a statement to the OTC. The statement of revocation or withdrawal must indicate that the
authority of the appointee is revoked, list appointee, tax matters and periods. The statement must be signed and dated by the taxpayer and
or representative. If the appointee is withdrawing, list the name, Social Security Number (SSN) / Employee Identification Number (EIN), and
address (if known) of the taxpayer.

Appointee Address Change
If the appointee’s address has changed, a new Form A-100 is not required. The appointee can send a written notification that includes
the new information and their signature to the OTC.

Specific Instructions
Section 1. Taxpayer Information
Individuals. Enter your name, Social Security Number (SSN)/Employer Identification Number (EIN), and your street address in the
space provided. Do not enter your appointee’s address or post office box. If a joint return is used, also enter your spouse’s name and SSN.
Corporations, Partnerships, or Associations. Enter the name, EIN, and business mailing address.
Trust. Enter the name, title, and address of the trustee, and the name and EIN of the trust.
Estate. Enter the name, title, and address of the decedent’s executor/personal representative, and the name and identification number
of the estate. The identification number for an estate includes both the EIN, if the estate has one, and the decedent’s SSN.

Section 2. Appointee
If you want to name more than one appointee, indicate so on this line and attach a list of appointees to Form A-100.
Enter your appointee’s full name. Use the identical full name on all submission and correspondence.
Enter the appointee’s telephone number and fax number for each appointee.

Section 3. Tax Matters
Enter the type of tax, the tax form number, the years or periods, and the specific tax matter. Enter “Not Applicable” in any of the columns
that do not apply.
Do not use a general reference such as “All years,” “All periods,” or “All taxes.” Any tax information authorization with a general
reference will not be processed.
You may list the current year or period and any tax years or periods that have already ended as of the date you sign the tax information
authorization. You must enter the type of tax, the tax form number, and the future year(s) or period(s). If the matter relates to estate tax,
enter the date of the decedent’s death instead of the year or period.
In Column (D), enter any specific information you want the OTC to provide. Examples of Column (D) information are; lien information, a
balance due amount, a specific tax schedule, or a tax liability.
For printed copies of returns, Form 599 (for income tax requests) or BT-199 (for business tax requests) must be completed and
submitted with the A-100. Payment of fees for copies must be included with the Form 599 or BT-199. If a payment is not received, the copy
request will be denied.

Section 4. Disclosure of Tax Information

Note: Any tax information authorization without a box selected will not be processed.
	

(A)	 Check this box if information is being disclosed pursuant to 68 OS Sec. 205(C)(23). A copy of the purchase contract must be
attached.

	

(B)	 Check this box if information is being disclosed pursuant to 68 OS Sec. 205(C)(16).

Section 5. Signature of Taxpayer(s)
	
If tax matter applies to a joint return, either husband or wife must sign. If signed by a corporate officer, partner, guardian, executor,
receiver, administrator, trustee, or party other than the taxpayer, I certify that I have the authority to execute this form with respect to the tax
matters/periods in Section 3 above.