Fillable Printable Bank Authorization Form - Minnesota
Fillable Printable Bank Authorization Form - Minnesota
Bank Authorization Form - Minnesota
Your signature or signature of partner Spouse’s signature (if filing joint) Date Daytime phone
I authorize the Minnesota Department of Revenue to initiate debit entries to my account as indicated above. This authority will remain in effect until the department has received
written or faxed (651-556-5130 or 651-556-3130) notification of its termination at least 30 days prior to the effective date.
Bank Authorization for Direct Debit for (year)
Your name or name of entity Social Security or Minnesota tax ID number
Spouse’s name, if ling joint (or partner if a partnership) Spouse’s Social Security number (if filing joint)
Street address
City State Zip code
Type of account
Checking
Savings
Complete if you are electronically ling your tax return (Form M1, M2, M3, M4, M4NP or M8), and you want to authorize a trans-
fer of funds from your account to pay tax owed as shown on your return. Do not complete if ling a paper return.
BANK
ERO: Attach to this form the Minnesota copies of all W-2, W-2G and 1099-R forms and
any other form that shows Minnesota income tax withheld and keep with your records.
Do NOT mail Form BANK to the Department of Revenue unless requested.
Routing number
Account number
9/10
Amount to be withdrawn
Enter the date you want
the amount withdrawn
from your account.
Form BANK instructions
If you are the taxpayer
Requesting the direct payment option is
voluntary and applies only to the electronic
return you are filing.
By signing the BANK form, you are autho‑
rizing the Department of Revenue to auto‑
matically withdraw the taxes due directly
from your checking or savings account.
You must sign and date this form. If you are
filing a joint return, your spouse must also
sign.
Your tax preparer is required to keep a
signed BANK form until the end of the
calendar year in which your return was
electronically filed.
If you are preparing your own return, keep
the BANK form with your tax records.
Do not mail this form to the Department
of Revenue.
If you are electronically filing your
Form M1, M2, M3, M4, M4NP
or M8, and you want to have your
taxes due automatically withdrawn
(direct payment) from your check-
ing or savings account, complete
Form BANK.
The Bank Authorization for Direct
Debit (BANK) complies with cur-
rent ACH rules.
If you are the Electronic
Return Originator (ERO)
Currently, the IRS requires you to keep
the W‑2, W‑2G and 1099 forms and other
documents for three years. You should also
keep with these IRS records the signed,
original Form BANK, Minnesota copies
of all W‑2, W‑2G and 1099 forms and any
other form that shows Minnesota income
tax withheld.
If you choose to discard Minnesota records
earlier, the minimum length of time you
must keep these documents on file is until
the end of the calendar year in which the
return was filed electronically.
If the Department of Revenue requests cop‑
ies of Form BANK and/or W‑2, W‑2G or
1099 forms, you must provide the informa‑
tion within five working days.
Do not mail Form BANK unless requested
to do so by the Department of Revenue.
