10

TLS, have you I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING

transmitted all R Action Date Signature
text files for this INSTRUCTIONS TO PRINTERS
cycle update? Form 8655, PAGE 1 of 2
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD to HEAD O.K. to print
PAPER: WHITE, WRITING, SUB. 20 INK: BLACK
FLAT SIZE: 216 mm (81⁄2 "
279 mm (11")
Date PERFORATE: NONE Revised proofs
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT requested

Form 8655
(Rev. May 2005)
Reporting Agent Authorization OMB No. 1545-1058
Department of the Treasury
Internal Revenue Service
Taxpayer
1a Name of taxpayer (as distinguished from trade name) 2 Employer identification number (EIN)

1b Trade name, if any 4 If you are a seasonal employer,

check here
3 Address (number, street, and room or suite no.) 5 Other identification number

City or town, state, and ZIP code

6 Contact person 7 Daytime telephone number 8 Fax number

( ) ( )
Reporting Agent
9 Name (enter company name or name of business) 10 Employer identification number (EIN)

11 Address (number, street, and room or suite no.)

City or town, state, and ZIP code

12 Contact person 13 Daytime telephone number 14 Fax number

( ) ( )
Authorization of Reporting Agent To Sign and File Returns
15 Use the entry lines below to indicate the tax return(s) to be filed by the reporting agent. Enter the beginning year of annual tax returns or
beginning quarter of quarterly tax returns. See the instructions for how to enter the quarter and year. Once this authority is granted, it is
effective until revoked by the taxpayer or reporting agent.

940 941 940-PR 941-PR 941-SS 943

943-PR 944 944-PR 945 1042 CT-1

Authorization of Reporting Agent To Make Deposits and Payments

16 Use the entry lines below to enter the starting date (the first month and year) of any tax return(s) for which the reporting agent is authorized to
make deposits or payments. See the instructions for how to enter the month and year. Once this authority is granted, it is effective until revoked
by the taxpayer or reporting agent.

940 941 943 944 945 720 1041

1042 1120 CT-1 990-C 990-PF 990-T

Disclosure of Information to Reporting Agents

17a Check here to authorize the reporting agent to receive or request copies of tax information and other communications from the IRS related
to the authorization granted on line 15 and/or line 16
b Check here if the reporting agent also wants to receive copies of notices from the IRS
Form W-2 series or Form 1099 series Disclosure Authorization
18a The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS
notices relating to the Form W-2 series information returns. This authority is effective for calendar year forms beginning .
b The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS
notices relating to the Form 1099 series information returns. This authority is effective for calendar year forms beginning .
State or Local Authorization
19 Check here to authorize the reporting agent to sign and file state or local returns related to the authorization granted on line 15 and/or
line 16
Authorization Agreement
I understand that this agreement does not relieve me, as the taxpayer, of the responsibility to ensure that all tax returns are filed and that all deposits and payments are made. If line
15 is completed, the reporting agent named above is authorized to sign and file the return indicated, beginning with the quarter or year indicated. If any starting dates on line 16 are completed,
the reporting agent named above is authorized to make deposits and payments beginning with the period indicated. Any authorization granted remains in effect until it is revoked by the taxpayer
or reporting agent. I am authorizing the IRS to disclose otherwise confidential tax information to the reporting agent relating to the authority granted on line 15 and/or line 16, including disclosures
required to process Form 8655. Disclosure authority is effective upon signature of taxpayer and IRS receipt of Form 8655. The authority granted on Form 8655 will not revoke any Power of Attorney
(Form 2848) or Tax Information Authorization (Form 8821) in effect.
I certify I have the authority to execute this form and authorize disclosure of otherwise confidential information on behalf of the taxpayer.
Sign
Here
䊳 Signature of taxpayer 䊳 Title 䊳 Date

For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 10241T Form 8655 (Rev. 5-2005)
 10
I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
Form 8655, PAGE 2 of 2
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD to HEAD
PAPER: WHITE, WRITING, SUB. 20 INK: BLACK
FLAT SIZE: 216 mm (81⁄2 "
279 mm (11")
PERFORATE: NONE
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 8655 (Rev. 5-2005) Page 2

Withdrawing from reporting authority. A reporting agent can
General Instructions withdraw from authority by filing a statement with the IRS, either on
What’s New paper or using a delete process. The statement must be signed by the
reporting agent (if filed on paper) and identify the name and address of
● Magnetic tape is no longer a filing method for the returns on the taxpayer and authorization(s) from which the reporting agent is
line 15. withdrawing. For information on the delete process, see Pub. 1474.
● The “Other” box in line 16 has been deleted. Authority to make
deposits and payments can only be granted for the forms listed in line Specific Instructions
16.
● New Forms 944 and 944-PR have been added to line 15. New Form Line 15
944 has been added to line 16. Form 944 should be available for Use the “YYYY” format for annual tax returns. Use the “MM/YYYY”
calendar year 2006. format for quarterly tax returns, where “MM” is the ending month of the
● Lines 18a and 18b have been added to allow taxpayers to grant quarter the named reporting agent is authorized to sign and file tax
reporting agents disclosure authority for the Form W-2 series and Form returns for the taxpayer. For example, enter “03/2005” on the line for
1099 series information returns. “941” to indicate you are authorizing the named reporting agent to sign
and file Form 941 for the January–March quarter of 2005 and
Purpose of Form subsequent quarters.
Form 8655 is used to authorize a reporting agent to:
Line 16
● Sign and file certain returns;
Use the “MM/YYYY” format to enter the starting date, where “MM” is
● Make deposits and payments for certain returns;
the first month the named reporting agent is authorized to make
● Receive duplicate copies of tax information, notices, and other deposits or payments for the taxpayer. For example, enter “08/2005”
written communication regarding any authority granted; and on the line for “720” to indicate you are authorizing the named
● Provide IRS with information to aid in penalty relief determinations reporting agent to make deposits or payments for Form 720 starting in
related to the authority granted on Form 8655. August 2005 and all subsequent months.

Authority Granted Who Must Sign

Once Form 8655 is signed, any authority granted is effective beginning Sole proprietorship–The individual owning the business.
with the period indicated on lines 15 or 16 and continues indefinitely Corporation (including an LLC treated as a corporation)–Generally,
unless revoked by the taxpayer or reporting agent. No authorization or Form 8655 can be signed by: (a) an officer having legal authority to
authority is granted for periods prior to the period(s) indicated on Form bind the corporation, (b) any person designated by the board of directors
8655. Disclosure authority by checking the box in line 17a is effective or other governing body, (c) any officer or employee on written request
with the dated signature of the taxpayer on Form 8655. by any principal officer, and (d) any other person authorized to access
Any authority granted on Form 8655 does not revoke and has no information under section 6103(e).
effect on any authority granted on Forms 2848 or 8821, or any Partnership (including an LLC treated as a partnership) or an
third-party designee checkbox authority. unincorporated organization–Generally, Form 8655 can be signed by any
person who was a member of the partnership during any part of the tax
Where To File period covered by Form 8655.
Send Form 8655 to: Single member limited liability company (LLC) treated as a
Internal Revenue Service disregarded entity–The owner of the LLC.
Accounts Management Service Center Trust or estate–The fiduciary.
MS 6748 RAF Team
1973 North Rulon White Blvd. Privacy Act and Paperwork Reduction Act Notice. We ask for the
Ogden, UT 84404 information on this form to carry out the Internal Revenue laws of the
You can fax Form 8655 to the IRS. The number is 801-620-4142. United States. Form 8655 is provided by the IRS for your convenience
and its use is voluntary. If you choose to authorize a reporting agent to
Additional Information act on your behalf, under section 6109, you must disclose your EIN.
Additional information concerning reporting agent authorizations may The principal purpose of this disclosure is to secure proper
be found in: identification of the taxpayer. We need this information to gain access
● Pub. 1474, Technical Specifications Guide for Reporting Agent to your tax information in our files and properly respond to your
Authorizations and Federal Tax Depositors, and request. If you do not disclose this information, the IRS may suspend
processing your reporting agent authorization and may not be able to
● Rev. Proc. 2003-69. You can find Rev. Proc. 2003-69 on
honor your reporting agent authorization until you provide your EIN.
page 403 of Internal Revenue Bulletin 2003-34 at
www.irs.gov/pub/irs-irbs/irb03-34.pdf. Routine uses of this information include giving it to the Department of
Justice for civil and criminal litigation, and to cities, states, and the
Substitute Form 8655 District of Columbia for use in administering their tax laws. We may
If you want to prepare and use a substitute Form 8655, see also disclose this information to other countries under a tax treaty, to
Pub. 1167, General Rules and Specifications for Substitute Forms and federal and state agencies to enforce federal nontax criminal laws, or to
Schedules. If your substitute Form 8655 is approved, the form approval federal law enforcement agencies and intelligence agencies to combat
number must be printed in the lower left margin of each substitute terrorism.
Form 8655 you file with the IRS. You are not required to provide the information requested on a form
that is subject to the Paperwork Reduction Act unless the form displays
Revoking an Authorization a valid OMB control number. Books or records relating to a form or
If you have a valid Form 8655 on file with the IRS, the filing of a new instructions must be retained as long as their contents may become
Form 8655 revokes the authority of the prior reporting agent beginning material in the administration of any Internal Revenue law.
with the period indicated on the new Form 8655. However, the prior The time needed to complete and file Form 8655 will vary depending
reporting agent is still an authorized reporting agent and retains any on individual circumstances. The estimated average time is 6 minutes.
previously granted disclosure authority for the periods prior to the If you have comments concerning the accuracy of this time estimate
beginning period of the new reporting agent’s authorization unless or suggestions for making Form 8655 simpler, we would be happy to
specifically revoked. hear from you. You can write to the Internal Revenue Service, Tax
If the taxpayer wants to revoke an existing authorization, send a Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111
copy of the previously executed Form 8655 to the IRS at the address Constitution Ave. NW, IR-6406, Washington, DC 20224. Do not send
under Where To File, above. Re-sign the copy of the Form 8655 under Form 8655 to this address. Instead, see Where To File above.
the original signature. Write REVOKE across the top of the form. If you
do not have a copy of the authorization you want to revoke, send a
statement to the IRS. The statement of revocation must indicate that
the authority of the reporting agent is revoked and must be signed by
the taxpayer. Also, list the name and address of each reporting agent
whose authority is revoked.