OMB No. 1545-1165 
                                              Tax Information Authorization                                                           For IRS Use Only 
Form  8821                       ▶ Go to www.irs.gov/Form8821 for instructions and the latest information.                       Received by: 
(Rev. January 2021)               ▶ Don’t sign this form unless all applicable lines have been completed.                        Name 
                                            ▶ Don’t use Form 8821 to request copies of your tax returns                          Telephone
Department of the Treasury                  or to authorize someone to represent you. See instructions.                          Function
Internal Revenue Service                                                                                                         Date
1  Taxpayer information. Taxpayer must sign and date this form on line 6. 
Taxpayer name and address                                                        Taxpayer identification number(s)

                                                                                 Daytime telephone number  Plan number (if applicable) 

2  Designee(s). If you wish to name more than two designees, attach a list to this form. Check here if a list of additional 
  designees is attached        ▶
Name and address                                                         CAF No. 
                                                                         PTIN 
                                                                         Telephone No. 
                                                                         Fax No. 
Check if to be sent copies of notices and communications                 Check if new: Address               Telephone No.                    Fax No. 
Name and address                                                         CAF No. 
                                                                         PTIN 
                                                                         Telephone No. 
                                                                         Fax No. 
Check if to be sent copies of notices and communications                 Check if new: Address               Telephone No.                    Fax No. 
3  Tax information.        Each designee is authorized to inspect and/or receive confidential tax information forthe  type of tax, forms, 
      periods, and specific matters you list below. See the line 3 instructions. 
        By checking here, I authorize access to my IRS records via an Intermediate Service Provider.
                    (a)                                (b)                            (c)                                             (d) 
 Type of Tax Information (Income,             Tax Form Number                    Year(s) or Period(s)               Specific Tax Matters
Employment, Payroll, Excise, Estate, Gift,    (1040, 941, 720, etc.)
Civil Penalty, Sec. 4980H Payments, etc.)  

4  Specific use not recorded on the Centralized Authorization File (CAF).             If the tax information authorization is for a 
      specificuse   not recorded on CAF, check this box. See the instructions. If you check this box, skip line 5  .             .   .    .   . . ▶

5  Retention/revocation of prior tax information authorizations. If the line 4 box is checked, skip this line. If the line 4 box 
      isn’t checked, the IRS will automatically revoke all prior tax information authorizations on file unless you check the line 5 
      box and attach a copy of the tax information authorization(s) that you want to retain   .          . . .  . . .            .   .    .   . . ▶
      To revoke a prior tax information authorization(s) without submitting a new authorization, see the line 5 instructions.

6  Taxpayer signature. If signed by a corporate officer, partner, guardian, partnership representative (or designated 
      individual, if applicable), executor, receiver, administrator, trustee, or individual other than the taxpayer, I certify that I have 
      the legal authority to execute this form with respect to the tax matters and tax periods shown on line 3 above.

      ▶ IF NOT COMPLETED, SIGNED, AND DATED, THIS TAX INFORMATION AUTHORIZATION WILL BE RETURNED. 

      ▶ DON’T SIGN THIS FORM IF IT IS BLANK OR INCOMPLETE. 

      Signature                                                                                            Date 

      Print Name                                                                                           Title (if applicable) 

For Privacy Act and Paperwork Reduction Act Notice, see the instructions.             Cat. No. 11596P                 Form 8821 (Rev. 01-2021)