Date: Name (Print):. Signature: Partnership, Corporation or Similar Entity: I designate.Filling out this form will provide the required information to verify they can. This dynamic PDF is not fillable if you open it in your internet browser. Please use these steps to download, save, and fill out the form. By signing this form, you allow us to share your protected health information (PHI) with the persons and organizations you put on this form. A collection of all the forms and documents you need to file and pay your City taxes and receive assistance, discounts, or refunds. These forms are provided in a fillable PDF format, which allows you to enter data directly into the form using your computer and Adobe Acrobat Reader. The templates on this page are intended to help investigators construct documents that are as short as possible and written in plain language. Authority to access electronic IRS records via Intermediate Service Providers.