Tax Return Release Form

PURPOSE FOR FORWARDING INFORMATION:*
- Mortgage/Finance
- Credit File
- Others
please describe:
DOCUMENTS TO BE RELEASED: (Please specify years i.e 2018 Individual Tax Return for John & Jane Smith)
NAME AND ADDRESS TO WHOM INFORMATION IS BEING DISCLOSED TO:
Company:
Contact Person:*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Fax
Email*
Duration of Consent
I, (please enter the name of the person who’s returns we are releasing)
*
, authorize Rosen & Associates, LLP to disclose to
*
the information listed above.
Signature*
Date*
MM slash DD slash YYYY
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