HomeMy WebLinkAboutHTAT-3 Bulk Filers Authorization FormFORM (202)
FORM
(202)
TAXPAYER INFORMATION
Taxpayer’s Name Hawaii Identification Number
Trade Name or Doing Business as (DBA) Name FEIN/SSN
C/O Contact Name
Mailing Address (Number and Street)Contact Daytime Telephone Number
( )
City, State, and Postal/ZIP Code Contact Fax Number
( )
Contact E-mail Address
REPORTING AGENT INFORMATION
Reporting Agent’s Name (Name of company or business) Authorized Representative’s Name
Reporting Agent’s Mailing Address (Number and Street) Representative’s Hawaii VPID Number
City, State, and Postal/Zip Code Representative’s Daytime Telephone Number
( )
AUTHORIZATION TO SIGN AND FILE TAX RETURNS AND TO MAKE PAYMENTS
The Reporting Agent and the above named Authorized Representative are authorized to sign and file the below indicated tax returns and to make
payments in connection with the below indicated tax returns:
, Periodic Tax Return ....................................for the period beginning
, ...................for the period beginning
AUTHORIZATION AGREEMENT
Please read the following Authorization Agreement:
The above named taxpayer understands the following responsibilities:
•The above named taxpayer is responsible for the actions of the Reporting Agent and the above named Authorized Representative in
connection with (a) the above indicated tax returns filed and (b) the related payments made;
•All tax returns must be timely filed and all taxes must be timely paid; and
•All filed tax returns are true, correct, and complete by the above named taxpayer.
The failure of the Reporting Agent and the above named Authorized Representative to comply with tax laws shall not absolve the above named
taxpayer of its responsibilities to comply with tax laws. The Reporting Agent and the above named Authorized Representative are authorized to sign
and file the above indicated tax returns and to make payments in connection with the above indicated tax returns for the above named taxpayer. This
authorization applies to the above indicated tax returns and related payments beginning with the indicated tax period and remains in effect until the
above named taxpayer notifies the Reporting Agent. I authorize the , , to disclose otherwise
confidential tax information to the Reporting Agent and the above named Authorized Representative in connection with the transmission of the
above indicated tax returns and related payments. I hereby certify under the penalties of perjury that I have the authority to authorize, on behalf of
the above named taxpayer, the Reporting Agent and the above named Authorized Representative (a) to sign and file the above indicated tax
returns, (b) to make payments in connection with the above indicated tax returns, and (c) to receive confidential information in connection with the
transmission of the above indicated tax returns and related payments.
Signature Date
Print Name Title
PART I
PART II
PART III
PART IV
FORM -3
202) PAGE 2
FORM 202)
GENERAL INSTRUCTIONS
PURPOSE OF THIS FORM
Use Form to designate and authorize a Reporting Agent and an Authorized
Representative to
sign and file returns
and to make tax
payments in
connection with the (BF).
The ’s
will allow approved reporting agents to
a worksheet
.
WHERE TO FILE THIS FORM
Once you complete and sign this form, give it to your
Reporting Agent. The Reporting Agent must keep the
form as part of its records and have it available for
examination
WHERE TO OBTAIN INFORMATION
REGARDING BULK FILING
The Reporting Agent must obtain Form
from you before applying to participate in
the BF on Form -2,BF
The Reporting Agent is responsible
for notifying you of the Reporting Agent’s eligibility to
participate in the .
For information about the Bulk program contact:
Website:
E-mail:
SPECIFIC INSTRUCTIONS
PART I, TAXPAYER INFORMATION. Enter the
taxpayer’s information (as applicable). For example, a
taxpayer authorizing the designated Reporting Agent and
Authorized Representative to sign and file Form
would enter the taxpayer’s name, I.D.
number, mailing address, and contact information.
PART II, REPORTING AGENT INFORMATION. Enter the
designated Reporting Agent’s name and mailing address.
Also enter the Authorized Representative’s name, Hawaii
VPID number, and daytime telephone number
including area code. Form -3 must be
completed for each individual who is an authorized
representative of the taxpayer.
Authorized representatives MUST register for a Hawaii
VPID number online at hitax.hawaii.gov. There is no fee
for this registration. For more information, see
Department of Taxation Announcement No.
2017-03, Verified Practitioner Registration and
Representing Taxpayers before the Department.
PART III, AUTHORIZATION TO SIGN AND FILE TAX
RETURNS AND TO MAKE PAYMENTS. Check all
applicable boxes to indicate which tax returns you are
authorizing your Reporting Agent and Authorized
Representative to electronically sign, file, and pay on
your behalf. Then enter the date (MM/DD/YYYY) from
which this authorization begins.
PART IV, AUTHORIZATION AGREEMENT. Carefully
read the authorization agreement and sign, date, and print
name and title. This form must be signed. This form is not
valid if it is not signed.
Note: This authorization agreement authorizes the
Reporting Agent and Authorized Representative to
discuss e-file return and payment procedures only. This
designation is not a full power of attorney and does not
replace Form
N-848, Power of Attorney.