AUTHORIZATION TO RELEASE RECORDS

*SAMPLE*

__________________________
            (Accountant)

   This is to acknowledge that you are authorized to release all of my/our tax and accounting records and other records that you may have in your possession to:.

   _________________________________________
                                 (Name)

   _________________________________________
                                (Address)

   _________________________________________
                                 (Phone)

Client Acknowledgement:

________________________________________  ____________________
                         (Signature)                                           (Date)

________________________________________  ____________________
                    (Printed Name)                                       (Phone)

Please sign and return this release in the envelope provided.