DISCLOSURE OF TAX RETURN INFORMATION

Federal law requires this consent form be provided to you.  Unless authorized by law, we cannot disclose, without your consent, your CONSENT A - CONSENT TO tax return information to third parties for purposes other than the preparation and filing of your tax return.  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.  If we obtain your signature on this form by conditioning our 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.

Please complete:  [To be completed by the taxpayer.]

• Purpose for forwarding information:                                                                                                            

• To whom is the information being disclosed to:

        Name                             ____________________________________________________

                        Address                        ____________________________________________________

                        City, State, Zip            ____________________________________________________

                        E-mail address           ____________________________________________________

                        Telephone                    ____________________________________________________

                        Facsimile                     ____________________________________________________

• Duration of Consent:         ____________________________________________________

I, ______________________________________, authorize D’Alessio Tocci & Pell to disclose to ________________________________ my tax return information for 200_________________________. 

Signature: ____________________________________________________________Date:____________

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 to: complaints@tigta.treas.gov