cl-contactfamily: Authorization to contact family of client with dementia

Dear [CLIENT NAME]:

Many of my clients would like me to contact a family member or friend if I cannot reach them, they have not filed a return, or if I have a concern about their financial decisions. If you would like to provide me with permission to release your tax information to a family member or friend, please sign below. You may revoke this permission at any time.

I, CLIENT NAME authorize TAX PROFESSIONAL NAME to contact NAME OF CONTACT at E-MAIL ADDRESS or PHONE NUMBER if TAX PROFESSIONAL NAME is unable to reach me, if I have not filed a tax return, or if TAX PROFESSIONAL NAME has a concern about my financial decisions.

I understand that I may revoke this permission in writing at any time.

Signed,

__________________________              ________________
Name                                                  Date