Exhibit A - Form 3337.pdf

Michigan Department of Treasury 3337 (Rev. 10-16)

Vendor, Contractor or Subcontractor Confidentiality Agreement The Revenue Act, Public Act 122 of 1941, MCL 205.28(1)(f), the City Income Tax Act, Public Act 284 of 1964, MCL 141.674(1), and Internal Revenu Code (IRC) 6103(d), make all information acquired in administering taxes confidential. The Acts and IRC hold a vendor, contractor or subcontractor an their employees who sell a product or provide a service to the Michigan Department of Treasury, or who access Treasury data, to the stric confidentiality provisions of the Acts and IRC. Confidential tax information includes, but is not limited to, information obtained in connection with th administration of a tax or information or parameters that would enable a person to ascertain the audit selection or processing criteria of the Michiga Department of Treasury for a tax administered by the department.

INSTRUCTIONS. Read this entire form before you sign it. If you do not complete this agreement, you will be denied access to Michigan Department o Treasury and federal tax information. After you and your witness sign and date this form, keep a copy for your records. Send the original to the addres listed below.

Company Name and Address (Street or RR#, City, State, ZIP Code) Last Name First Name

Driver License Number/Passport Number Telephone Number

State of Michigan Department Division Subcontractor Name if Product/Service Furnished to Contractor

Describe here or in a separate attachment the product or service being provided to the State of Michigan Agency (Required).

Confidentiality Provisions. It is illegal to reveal or browse, except as authorized:

All tax return information obtained in connection with the administration of a tax. This includes information from a tax return or audit and any information about the selection of a return for audit, assessment or collection, or parameters or tolerances for processing returns.

All Michigan Department of Treasury or federal tax returns or tax return information made available, including information marked "Official Use Only".

Tax returns or tax return information shall not be divulged or made known in any manner to any person except as may be needed to perform official duties. Access to Treasury or federal tax information, in paper or electronic form, is allowed on a need-to-know basis only. Before you disclose returns or return information to other employees in your organization, they must be authorized by Michigan Department of Treasury to receive the information to perform their official duties.

Confidential information shall not be disclosed by a department employee to confirm information made public by another party or source which is part of any public record. 1999 AC, R 2005.1004(1).

Violating confidentiality laws is a felony, with penalties as described:

Michigan Penalties MCL 205.28(1)(f) provides that you may not willfully disclose or browse any Michigan tax return or information contained in a return. Browsing is defined as examining a return or return information acquired without authorization and without a need to know the information to perform official duties.

Violators are guilty of a felony and subject to fines of $5,000 or imprisonment for five years, or both. State employees will be discharged from state service upon conviction.

Any person who violates any other provision of the Revenue Act, MCL 205.1, et seq., or any statute administered under the Revenue Act, will be guilty of a misdemeanor and fined $1,000 or imprisonment for one year, or both, MCL 205.27(4).

City Penalties MCL 141.674(2) provides that any person divulging confidential City Tax information is guilty of a misdemeanor and subject to a fine not exceeding $500 or imprisonment for a period not exceeding 90 days, or both, for each offense.

Federal Penalties If you willfully disclose federal tax returns or tax return information to a third party, you are guilty of a felony with a fine of $5,000 or imprisonment for five years, or both, plus prosecution costs according to the Internal Revenue Code (IRC) §7213, 26 USC 7213.

In addition, inspecting, browsing or looking at a federal tax return or tax return information without authorization is a felony violation of IRC §7213A subjecting the violator to a $1,000 fine or imprisonment for one year, or both, plus prosecution costs. Taxpayers affected by violations of §7213A must be notified by the government and may bring a civil action against the federal government and the violator within two years of the violation. Civil damages are the greater of $1,000 or actual damages incurred by the taxpayer, plus the costs associated with bringing the action, 26 USC 7431.

Failure to comply with this confidentiality agreement may jeopardize your employer's contract with the Michigan Department of Treasury.

Certification By signing this Agreement, I certify that I have read the above confidentiality provisions and understand that failure to comply is a felony.

Print name of employee signing this agreement Signature of person named above Date signed

Print Witness Name (Required) Signature of Witness (Required) Date signed

Submit your form to the following address:

Office of Privacy and Security/ Disclosure Unit Michigan Department of Treasury 430 W. Allegan Street Lansing, MI 48922

Questions, contact the Office of Privacy and Security by telephone, 517-636-4239; fax, 517-636-5340; or email:

Treas_Disclosure@michigan.gov e d t e n f s mailto:Treas_Disclosure@michigan.gov