West Palm Beach Florida car accident information request from the Director of Department of State Taxation

Dear Sir:

I have retained the law firm of (insert name and address of law firm) to represent me in legal proceedings to which I am a party. I hereby authorize the firm to request and secure copies of my state income tax returns, with any accompanying schedules, for the years (insert appropriate years).

Sincerely,

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(Signature of Client)

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(Insert Name and Address of Client)

Subscribed and sworn to before me this day of , 20 .

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Notary Public