Form A-100 Fillable Disclosure of Tax Information Authorization
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

Allperiods Income Print REVOKE (: No) Unchecked (: Yes) Unchecked (405) (A) Information (B) Information (checkbox) Unchecked (EIN) (SSN) (SSN)/Employer (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (thru (Title 1 Taxpayer Information Taxpayer(s) 2 Appointee If 205 24) 205(c)17) 26800 3 Tax Matters The 4 Disclose Tax Information 5 Signature of Taxpayer(s) See Instructions 521 3160 7 2012 73126 0800Questions A 100 A 100 A 100 A 100 Oklahoma Tax Commission above above across address address address address Address administrator advocate agreements; already amount and/or anindividual applicable applicable) applies apply appointee appointee appointee appointee appointee Appointee Address Change appointee s appointee s appointees assessments attach attached attest Attorney authority Authority authorization authorization authorization authorize authorize authorized authorizes balance become before being being below BT129 business business businessactivities calendar Call: certify changed check Check Check the appropriate box: closing Column Column (D) Commission Commission Commission Commission Commission Company completed confidential confidentiality consents contractmust corporate corporation Corporations Partnerships or Associations Enter correspondence current dated Daytime death decedent s decedent s designate disclosed disclosure Disclosure of Tax Information Authorization donot either husband Employee Employer ended ending enter enter enter Enter Enter established estate estate Estate Enter example Examples execute executed executor executor/personal existing extent filed files final Forfiscal format future general General Instructions guardian hyphen) identical identification Identification identificationnumber identified If not signed and dated this Tax Information Authorization will not be processed includes includingquarterly inclusive indicate indictated individual Individuals Enter information information information information information information information information inspect instead inthe joint known) laws; liabilities liability lines listed mailing matter matter matters matters/periods mattersand month multiple musthave Name(s) nameand necessary notification number number number Number Number Number Number Number(s) O S ) office Office officer ofthe Oklahoma Oklahoma Oklahoma Oklahoma Oklahoma Oklahoma organization original other otherwise partner partnership party period period(s) periods periods periods persons pertaining position Power previously Procedure processed prospective provide provided provisions purchase Purpose of Form pursuant Pursuant receive received receiver recorded records reference relate relatesto relating released represent representative request requested required respect respectto return Revised revocation Revocation of an Existing Tax Information Authorization revoke revoked schedule Section Section Section Section Section 1 Taxpayer Information Section 2 Appointee Section 3 Tax Matters Section 4 Disclosure of Tax Information Section 5 Signature of Taxpayer(s) Security Security series signature signature Signature signed signed Social Social space Special specific specific Specific Instructions specifically spouse s statement statement street submission taxes taxpayer taxpayer Taxpayer telephone Telephone thatincludes thecolumns their thename theOklahoma through title Title Title trust Trust Enter trustee under Uniform unless using waiver waivers warrants When To File which whichhave withdrawal withdrawing within written year(s) years years years yourconfidential YYYYMM