Form 156 Fillable Authorization for the Release of Tax Records/Information
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

I may inspect my confidential tax information without signing this form I may receive a copy of this form This authorization is voluntary (*Also known as) (2010) Unchecked (2011) Unchecked (2012) Unchecked (2013) Unchecked (AGENCY) (At my request) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (CITY) (DATE OF BIRTH) (Date) (Employment) Unchecked (Healthcare) Unchecked (NAME) (Other) Unchecked (Payment/Insurance) Unchecked (Phone Number) (PHONE NUMBER) (Power of Attorney Letter of Administration etc ): (Printed Name of Taxpayer or Personal Representative) (Printed Name of Witness) (SOCIAL SECURITY NUMBER) (STATE) (STREET ADDRESS) (TAXPAYER*:) (This authorization will expire one year from the date it is signed unless a shorter period of time is indicated here) (undefined) (ZIP CODE) *Also known as 110 Carroll Street 156 TAX RECORDS/INFORMATION AGENCY Annapolis Maryland 21411 Any and all tax records and/or information (including liabilities delinquencies liens etc ) for the following years: At my request Payment/Insurance Healthcare Employment Other: Authorization For The Release of Tax Records COM/RAD 756 (Rev 02/13) Comptroller of Maryland DATE OF BIRTH Date Printed Name of Witness FORM AUTHORIZATION FOR THE RELEASE OF I hereby authorize the Comptroller of Maryland to release the confidential Maryland tax records and information of: I understand: If the signature is other than the taxpayer s explain your authority to act for the taxpayer and attach the appropriate documentation Legal Section FAX: 410 974 2968 MAIL TO: OFFICE USE ONLY Other Phone Number PHONE NUMBER Photocopied by Reviewed by Printed Name of Taxpayer or Personal Representative prior to receipt of revocation To revoke the authorization I understand that I must notify the Comptroller of Maryland in writing Researcher s Initials Date Date Copies/Info Released Revenue Administration Division Signature of Witness SOCIAL SECURITY NUMBER STATE STREET ADDRESS Tax Year(s) Account No (s) Taxpayer s Signature(s) verified by Taxpayer or Personal Representative s Signature TAXPAYER*: The information is to be released to: The purpose for such disclosure is: This authorization to disclose information may be revoked by me at any time except to the extent that action has been taken This authorization will expire one year from the date it is signed unless a shorter period of time is indicated here: ZIP CODE