Form WIC-8 "Waiver of Rights Under N.j.s.a. 54:50-8 and Authorization for Release of Tax Return Information to Department of Health" - New Jersey

What Is Form WIC-8?

This is a legal form that was released by the New Jersey Department of the Treasury - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2015;
  • The latest edition provided by the New Jersey Department of the Treasury;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form WIC-8 by clicking the link below or browse more documents and templates provided by the New Jersey Department of the Treasury.

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Download Form WIC-8 "Waiver of Rights Under N.j.s.a. 54:50-8 and Authorization for Release of Tax Return Information to Department of Health" - New Jersey

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D EPARTMENT OF TR EA SUR Y
D I V I S I O N O F T A X A T I O N
WIC PROJECT
PO BOX 445
TRENTON, N. J. 08625-0445
WAIVER OF RIGHTS UNDER N.J.S.A. 54:50-8 AND
AUTHORIZATION FOR RELEASE OF TAX RETURN INFORMATION
TO DEPARTMENT OF HEALTH
This form to be completed by the WIC vendor.
_____________________________________________________________________________________________
Print Name of WIC Vendor:
Print Street Address:
Print Town:
Telephone Number:
Print Name of Contact Person:
and Title:
Tax Identification Number:
_____________________________________________________________________________________________
This undersigned hereby authorizes the Division of Taxation to release tax return information to the
Department of Health (DOH) for the sole and exclusive purpose of administration of the responsibilities
under Federal Public Law 108-265.
The Taxation data subject to release to DOH may include the name, address and business gross receipts
for WIC vendors identified by DOH.
By signing this form, the undersigned releases the New Jersey Division of Taxation and its contractor from
the obligation to maintain the confidentiality of tax return information under N.J.S.A. 54:50-8.
The undersigned also waives all right to make any claim against the Division of Taxation and its contractor
for the limited release of tax information to DOH.
The undersigned represents that he/she is authorized to sign this waiver on behalf of the vendor for the
purpose set forth herein.
_____________________________________________________________________________________________
Print Name of Owner, Partner or Officer of Vendor and Title
Signature of Owner, Partner or Officer of Vendor and Title
Date
WIC-8
JUN 15
D EPARTMENT OF TR EA SUR Y
D I V I S I O N O F T A X A T I O N
WIC PROJECT
PO BOX 445
TRENTON, N. J. 08625-0445
WAIVER OF RIGHTS UNDER N.J.S.A. 54:50-8 AND
AUTHORIZATION FOR RELEASE OF TAX RETURN INFORMATION
TO DEPARTMENT OF HEALTH
This form to be completed by the WIC vendor.
_____________________________________________________________________________________________
Print Name of WIC Vendor:
Print Street Address:
Print Town:
Telephone Number:
Print Name of Contact Person:
and Title:
Tax Identification Number:
_____________________________________________________________________________________________
This undersigned hereby authorizes the Division of Taxation to release tax return information to the
Department of Health (DOH) for the sole and exclusive purpose of administration of the responsibilities
under Federal Public Law 108-265.
The Taxation data subject to release to DOH may include the name, address and business gross receipts
for WIC vendors identified by DOH.
By signing this form, the undersigned releases the New Jersey Division of Taxation and its contractor from
the obligation to maintain the confidentiality of tax return information under N.J.S.A. 54:50-8.
The undersigned also waives all right to make any claim against the Division of Taxation and its contractor
for the limited release of tax information to DOH.
The undersigned represents that he/she is authorized to sign this waiver on behalf of the vendor for the
purpose set forth herein.
_____________________________________________________________________________________________
Print Name of Owner, Partner or Officer of Vendor and Title
Signature of Owner, Partner or Officer of Vendor and Title
Date
WIC-8
JUN 15