State Board of Individual Tax Preparers - Individual Tax Preparer Original Application


Preparer Tax Identification Number (PTIN): P
   
Expiration Date of PTIN (must be after today’s date): / /

Please note the required follow-up forms after the completion of this application:

In order to complete the registration process, please submit a copy of one of the two documents listed below, allowing the Board to verify your federal PTIN registration:
  1. The PTIN Application Confirmation screen from the electronic transaction that you used to apply for your federal PTIN,

    OR

  2. The Welcome Letter you received from the IRS subsequent to your PTIN Application Confirmation. To request a duplicate Welcome Letter, please call the IRS at 1-877-613-PTIN (7846).
Documentation can be:

E-mailed to: indtaxprep@dllr.state.md.us
  
Mailed to: Tax Preparers, 500 North Calvert Street, Third Floor, Baltimore MD 21202
  
Faxed to: 410-333-6314 (Attn: Tax Preparers)

Failure to submit the requested information will prevent the final processing of your registration application.

Full Name:



, -
County:


- - (MM-DD-YYYY)
Place of Birth:

and : ,

:
- -

Education: Please indicate all levels completed.
 
A. Secondary Education: High School Diploma GED
 
B. Higher Education: Undergraduate Degree       Graduate Degree
 

1. Have you ever been convicted of a felony or misdemeanor in any State, District of Columbia or Federal court?
2. Have you ever had this type of registration denied, suspended, or revoked by Maryland, any other State or the District of Columbia?
3. Have you been convicted of or received probation before judgment of any drug offense committed after January 1,1991?

 I have Workers Compensation Coverage   Policy/Binder No.

Issued by the  

 I am not an employer required to provide employee coverage under the Workers Compensation Law.


Certification

By pressing "Submit" below:

    I hereby certify, under penalty of perjury, that the information contained herein is true and correct to the best of my knowledge, information, and belief. I further authorize the release of any information contained within this application to an authorized representative of the Department of Labor, Licensing and Regulation for further investigation. I further certify that I have paid all undisputed taxes and unemployment insurance contributions payable to the Comptroller or the Department of Labor, Licensing and Regulation or have provided for payment in a manner satisfactory to the unit responsible for collection.



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