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REV187 taxes.state.mn.us

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This document is an authorization form for the Minnesota Department of Revenue to communicate tax information via email. It contains spaces for the taxpayer's name, address, social security number, and signature authorizing the department to send private tax data over email. The form notes that the taxpayer accepts the risk of unauthorized access and can revoke the authorization at any time by written notice. It also states that the department is not liable for any damages resulting from third party interception of emailed tax information.

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REV187 Authorization to Communicate through E-mail Transmission Your name or name of entity Social Security or Minnesota tax ID number (or FEIN) Spouse’s name, if joint (or corporate officer, partner or fiduciary if a business) Spouse’s Social Security number, if joint Please print Your e-mail address (or e-mail address of spouse, entity or representative) Check if the above e-mail address is for: You Spouse Entity Representative (name ) I authorize the Minnesota Department of Revenue to communicate through the above e-mail address with me, or the entity for which I am signing, or with my or the entity’s representative named in a separate Power of Attorney. I understand that private tax data about me, or nonpublic tax data about the entity, may be transmitted over the Internet. I or the entity accepts the risk that the data may be accessed by someone other than the intended recipient. Authorization This authorization remains in effect until I or the entity notifies the Minnesota Department of Revenue in writing (either by mail or facsimile transmission) that the authorization is revoked. This authorization may be revoked by me or the entity at any time. If this is an authorization to allow the Minnesota Department of Revenue to communicate electronically with my appointed tax representative, I understand that the authorization remains in effect only as long as the Power of Attorney granted to that representative remains in effect. I further agree that the Minnesota Department of Revenue is not liable for any damages I or the entity may incur as a result of interception by a third party of an e-mail transmission sent by the department pursuant to this authorization. This authorization is not valid unless signed and dated. Your spouse may also sign if you file jointly. Your signature or signature of corporate officer, partner or fiduciary Print your name (and title, if applicable) Date Phone Sign here Spouse’s signature (if joint) Print spouse’s name (if joint) Date Phone Return the completed form to the Minnesota Department of Revenue representative who requested it. (12/05)

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REV187 taxes.state.mn.us

  • 1. REV187 Authorization to Communicate through E-mail Transmission Your name or name of entity Social Security or Minnesota tax ID number (or FEIN) Spouse’s name, if joint (or corporate officer, partner or fiduciary if a business) Spouse’s Social Security number, if joint Please print Your e-mail address (or e-mail address of spouse, entity or representative) Check if the above e-mail address is for: You Spouse Entity Representative (name ) I authorize the Minnesota Department of Revenue to communicate through the above e-mail address with me, or the entity for which I am signing, or with my or the entity’s representative named in a separate Power of Attorney. I understand that private tax data about me, or nonpublic tax data about the entity, may be transmitted over the Internet. I or the entity accepts the risk that the data may be accessed by someone other than the intended recipient. Authorization This authorization remains in effect until I or the entity notifies the Minnesota Department of Revenue in writing (either by mail or facsimile transmission) that the authorization is revoked. This authorization may be revoked by me or the entity at any time. If this is an authorization to allow the Minnesota Department of Revenue to communicate electronically with my appointed tax representative, I understand that the authorization remains in effect only as long as the Power of Attorney granted to that representative remains in effect. I further agree that the Minnesota Department of Revenue is not liable for any damages I or the entity may incur as a result of interception by a third party of an e-mail transmission sent by the department pursuant to this authorization. This authorization is not valid unless signed and dated. Your spouse may also sign if you file jointly. Your signature or signature of corporate officer, partner or fiduciary Print your name (and title, if applicable) Date Phone Sign here Spouse’s signature (if joint) Print spouse’s name (if joint) Date Phone Return the completed form to the Minnesota Department of Revenue representative who requested it. (12/05)