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Get Social Security Number(s) For IRS Use Only Received By: Name Telephone ( Function Date ) 1 Taxpayer

ON IS NOT SIGNED AND DATED, IT WILL BE RETURNED. Telephone ( ) Function Date 1 Taxpayer information. Taxpayer name(s) and address (please type or print) Social security number(s) / / Employer identification number Daytime telephone number Plan number (if applicable) ( ) 2 Appointee. Name and address (please type or print) CAF No. ) Telephone No. ( ( ) Fax No. Check if new: Address Telephone No. 3 Tax matters. The appointee is authorized to inspect and/or receive confidential tax inf.

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