IRS Form W-12 "IRS Paid Preparer Tax Identification Number (Ptin) Application and Renewal"

This "Irs Form W-12 "irs Paid Preparer Tax Identification Number (Ptin) Application and Renewal"" is a document issued by the U.S. Department of the Treasury - Internal Revenue Service specifically for United States residents with its latest version released on October 1, 2019.

Download the up-to-date fillable PDF by clicking the link below or find it on the forms website of the U.S. Department of the Treasury - Internal Revenue Service.

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Download IRS Form W-12 "IRS Paid Preparer Tax Identification Number (Ptin) Application and Renewal"

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W-12
IRS Paid Preparer Tax Identification Number (PTIN)
Form
Application and Renewal
OMB No. 1545-2190
(Rev. October 2019)
Department of the Treasury
Go to www.irs.gov/FormW12 for instructions and the latest information.
Internal Revenue Service
1 Name and PTIN
First name
Middle name
Last name
(Print in ink or
Type)
Initial application
Renewal application
(Enter PTIN: P
)
2 Year of
If you checked the “Initial application” box and are submitting this form between October 1 and December 31,
Application/
indicate below whether you want your PTIN to be valid for the current calendar year or the next calendar year.
Renewal
Current calendar year
Next calendar year
Prior year(s) (YYYY): Check box(es) below for the prior year(s) you are renewing your PTIN. See line 2
instructions for additional guidance.
2016
2017
2018
Other prior year(s)
3 SSN and Date
SSN
Date of birth (MM/DD/YYYY)
of Birth
-
-
/
/
Street address. Use a P.O. box number only if the post office does not deliver mail to your street address.
4 Personal
Mailing
Address and
Phone Number
City or town, state or province, country, and ZIP or foreign postal code. Do not abbreviate name of country.
Phone Number (
)
-
5a Business
Business address
Check here if your business address is the same as your personal mailing address. If
Mailing
different, enter it below.
Address and
Phone Number
City or town, state or province, country, and ZIP or foreign postal code. Do not abbreviate name of country.
Domestic business phone number
International business phone number
(
)
-
EXT.
+
b Business
Are you self-employed or an owner, partner, or officer of a tax return preparation business?
Yes
No
Identification
If “Yes,” then complete this line. If “No,” go to line 6.
Enter the business name.
Your CAF Number
EIN
EFIN
-
Website address (optional)
6 Email Address
Enter the email address that should be used to contact you.
W-12
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Form
(Rev. 10-2019)
Cat. No. 55469F
For Internal Use Only
F:
E:
A:
W-12
IRS Paid Preparer Tax Identification Number (PTIN)
Form
Application and Renewal
OMB No. 1545-2190
(Rev. October 2019)
Department of the Treasury
Go to www.irs.gov/FormW12 for instructions and the latest information.
Internal Revenue Service
1 Name and PTIN
First name
Middle name
Last name
(Print in ink or
Type)
Initial application
Renewal application
(Enter PTIN: P
)
2 Year of
If you checked the “Initial application” box and are submitting this form between October 1 and December 31,
Application/
indicate below whether you want your PTIN to be valid for the current calendar year or the next calendar year.
Renewal
Current calendar year
Next calendar year
Prior year(s) (YYYY): Check box(es) below for the prior year(s) you are renewing your PTIN. See line 2
instructions for additional guidance.
2016
2017
2018
Other prior year(s)
3 SSN and Date
SSN
Date of birth (MM/DD/YYYY)
of Birth
-
-
/
/
Street address. Use a P.O. box number only if the post office does not deliver mail to your street address.
4 Personal
Mailing
Address and
Phone Number
City or town, state or province, country, and ZIP or foreign postal code. Do not abbreviate name of country.
Phone Number (
)
-
5a Business
Business address
Check here if your business address is the same as your personal mailing address. If
Mailing
different, enter it below.
Address and
Phone Number
City or town, state or province, country, and ZIP or foreign postal code. Do not abbreviate name of country.
Domestic business phone number
International business phone number
(
)
-
EXT.
+
b Business
Are you self-employed or an owner, partner, or officer of a tax return preparation business?
Yes
No
Identification
If “Yes,” then complete this line. If “No,” go to line 6.
Enter the business name.
Your CAF Number
EIN
EFIN
-
Website address (optional)
6 Email Address
Enter the email address that should be used to contact you.
W-12
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Form
(Rev. 10-2019)
Cat. No. 55469F
For Internal Use Only
F:
E:
A:
2
Form W-12 (Rev. 10-2019)
Page
7 Past Felony
Yes
Have you been convicted of a felony in the past 10 years?
Convictions
No
You must check
If “Yes,” list the date and the type of felony conviction(s).
a box. If “Yes,”
you must
provide an
explanation.
If this is your initial application for a PTIN, continue to line 8. If you are renewing your PTIN, go to line 10.
8 Address of
Enter the address used on your last U.S. individual income tax return you filed.
Your
Last U.S.
Individual
Income Tax
Check here if you have never filed a U.S. income tax return or do not have a U.S. income tax filing
Return Filed
requirement. See line 8 instructions for documents that must be submitted with this form and continue to
line 10.
9 Filing Status
Single
Head of Household
and Tax Year
on Last U.S.
Married filing jointly
Qualifying widow(er) with dependent child
Individual
Income Tax
Married filing separately
Tax Year (YYYY)
Return Filed
Note: If your last return was filed more than 4 years ago, see instructions.
10 Federal Tax
Are you current on both your individual and business federal taxes, including any corporate and employment
Compliance
tax obligations? Note: If you have never filed a U.S. individual income tax return because you are not required
to do so, check the “Yes” box.
Yes
No
If “No,” provide an explanation.
11 Data Security
As a paid tax return preparer, I am aware of my legal obligation to have a data security plan and to provide data
Responsibilities
and system security protections for all taxpayer information. Check the box to confirm you are aware of this
responsibility.
W-12
Form
(Rev. 10-2019)
3
Form W-12 (Rev. 10-2019)
Page
12 Professional
Check all that apply. Note: DO NOT check any professional credentials that are currently expired or
Credentials
retired. Enter state abbreviation and appropriate number(s). If the expiration date is left blank or incomplete,
then NO professional credential will be added when the application is processed.
Attorney—Licensed in which
jurisdiction(s):
Number(s):
Expiration Date(s):
Certified Public Accountant (CPA)—
Licensed in which jurisdiction(s):
Number(s):
Expiration Date(s):
Number(s):
Expiration Date(s):
Enrolled Agent (EA)
Number(s):
Expiration Date(s):
Enrolled Actuary
Number(s):
Expiration Date(s):
Enrolled Retirement Plan Agent (ERPA)
State Regulated Tax Return Preparer
—Licensed in which jurisdiction(s):
Number(s):
Expiration Date(s):
Number:
Certifying Acceptance Agent (CAA)
None
Under penalties of perjury, I declare that I have examined this application and to the best of my knowledge and belief, it
is true, correct, and complete. I understand any false or misleading information may result in criminal penalties and/or
Sign
the denial or termination of a PTIN.
Your signature (Please use blue or black ink)
Date (MM/DD/YYYY)
Here
/
/
How To File
Online. Go to the webpage www.irs.gov/ptin for information. Follow the instructions to submit Form W-12. If you submit your
application online, your PTIN generally will be provided to you immediately after you complete the application.
By mail. Complete Form W-12. Send the form to:
IRS Tax Professional PTIN
Processing Center
1605 George Dieter PMB 678
El Paso, TX 79936
Note: Allow 4 to 6 weeks for processing of PTIN applications. For additional information, refer to the separate Instructions for
Form W-12.
For Internal Use Only
W-12
Form
(Rev. 10-2019)
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