2135 Rimrock Road, P.O. Box 7843, Madison, WI 53707-7843

(608) 266-1311 | 1-800-WIS-VETS (947-8387)

INCOME TAX RELEASE AUTHORIZATION

Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04(1)(m)].
The provision of your social security number is voluntary. Failure to provide your social security number may result in an information processing delay.

The Wisconsin Department of Veterans Affairs is authorized to examine any of my income tax returns, or any schedules, exhibits, writings or audit reports pertaining to the same, on file with the State of Wisconsin, Department of Revenue.

Veteran Signature
Date
Print Name
Address
Year(s) to Request
Social Security Number
Spouse Signature
Date
Print Name
Address
Social Security Number

WDVA (09/98)

F:\APPLIC\WINWORD\TEMPLATE\1DVAMLAN.DOT

WDVA 1035 (08/09)	You can print the most recent version of this form

W:\Templates\WDVA_1035_Income_Tax_Release_Authorization.dot	from the WDVA website at

http://dva.state.wi.us/Pages/newsmedia/WDVAToolkit.aspx

Wis. Stats. Chapter 45

WDVA 1035 - Income Tax Release Authorization

Fay, Becky

2016-10-26

Jacobs, Pam

Dept of Veterans Affairs