Form MDT-ADM-023 "Third Party Authorization to E-File" - Montana

What Is Form MDT-ADM-023?

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

Form Details:

  • Released on September 1, 2020;
  • The latest edition provided by the Montana Department of Transportation;
  • 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 fillable version of Form MDT-ADM-023 by clicking the link below or browse more documents and templates provided by the Montana Department of Transportation.

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Download Form MDT-ADM-023 "Third Party Authorization to E-File" - Montana

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PO Box 201001
Montana Department of Transportation
2701Prospect Ave
Helena MT 59620-1001
Motor Fuel Section
406-444-7664
MDT-ADM-023
09/20
Third Party Authorization to e-File
Page 1 of 1
Taxpayer Information
Social Security Number or
Taxpayer's Name
Federal Identification Number
Spouse's Name
Social Security Number or
Federal Identification Number
Taxpayer Declaration and Signature Authorization
Under penalties of perjury, I declare that I have examined a copy of my electronic refund application and
accompanying schedules and statements, and to the best of my knowledge and belief, they are true,
correct, and complete. I further declare that I consent to allow my intermediate service provider, transmitter,
or electronic return originator (ERO) to send my refund application to MDT and to receive from MDT (a) an
acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in
processing refund, and (c) the date of any refund. The appointed representative(s) is not authorized to
receive confidential information and perform any acts without a Power of Attorney on file. This authorization
is to remain in full force and effect until I notify MDT to terminate the authorization.
Taxpayer's Signature
Date
Spouse's Signature
Date
Third Party Preparer
Company Name
Phone Number
Address
City
State
Zip Code
Certification and Authorization
Under penalties of perjury, I declare that the above taxpayer has granted my company permission to
electronically transmit data to the MDT. I have examined a copy of the electronic refund application and
accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct,
and complete.
Third Party Preparer Signature
Date
PO Box 201001
Montana Department of Transportation
2701Prospect Ave
Helena MT 59620-1001
Motor Fuel Section
406-444-7664
MDT-ADM-023
09/20
Third Party Authorization to e-File
Page 1 of 1
Taxpayer Information
Social Security Number or
Taxpayer's Name
Federal Identification Number
Spouse's Name
Social Security Number or
Federal Identification Number
Taxpayer Declaration and Signature Authorization
Under penalties of perjury, I declare that I have examined a copy of my electronic refund application and
accompanying schedules and statements, and to the best of my knowledge and belief, they are true,
correct, and complete. I further declare that I consent to allow my intermediate service provider, transmitter,
or electronic return originator (ERO) to send my refund application to MDT and to receive from MDT (a) an
acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in
processing refund, and (c) the date of any refund. The appointed representative(s) is not authorized to
receive confidential information and perform any acts without a Power of Attorney on file. This authorization
is to remain in full force and effect until I notify MDT to terminate the authorization.
Taxpayer's Signature
Date
Spouse's Signature
Date
Third Party Preparer
Company Name
Phone Number
Address
City
State
Zip Code
Certification and Authorization
Under penalties of perjury, I declare that the above taxpayer has granted my company permission to
electronically transmit data to the MDT. I have examined a copy of the electronic refund application and
accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct,
and complete.
Third Party Preparer Signature
Date