PDF REVENUE DIVISION OF DEPARTMENT OF TREASURY Act 122 of ... 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Part 1, where you will enter your Taxpayer or Debtor Information. Ensure to fill in your name, FEIN, and address as these fields are marked as required.
3. Move to Part 2 if you need to revoke any previous authorizations. Check the appropriate box based on whether you want to revoke all prior authorizations or specific ones.
4. In Part 3, appoint your representative by providing their name and contact details. If appointing an entity, include a contact person’s name.
5. Proceed to Part 4 to specify the type of authority you wish to grant your representative. Check the relevant boxes for actions they can perform on your behalf.
6. If applicable, complete Part 5 to request copies of letters and notices regarding tax disputes by entering the necessary tax types and periods.
7. Finally, sign in Part 6 to authorize Treasury communication with your representative. Ensure all required fields are completed before submitting.

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