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If ACH Debit is chosen the taxpayer hereby authorizes the Tennessee Department of Revenue to present debit entries into the bank account given above. These debit entries will pertain only to Electronic Funds Transfer Payments that the taxpayer has initiated. Signature RV-F1304601 Rev. 3-12 Title Date FOR TAX ACCOUNTS If you want to combine several outlets into one payment transaction then you only need to sign and return one number below and retu.

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