Mail To: Office of the Attorney General Employer Services P.O. Box 12017 MC-046 Austin, TX 78711-2017 800-850-6442 www.employer.texasattorneygeneral.gov OAG USE ONLY Date Received: __________ EID: ___________________ Employer Authorization for Third Party Reporting EMPLOYER INFORMATION Employer Name: ______________________________ Contact Phone: ______________________________ Employer FEIN: ______________________________ Employer Contact: ______________________________ Contact Email: ______________________________ The Third Party agent listed below is designated to transact all business that needs to be performed with the Office of the Attorney General, Child Support Division (OAG CSD) on the Employer's behalf. This authorization shall be in effect until a new Employer Authorization for Third Party Reporting is received from the Employer, or form 1841, Revocation of Authorization for Third Party Reporting, is submitted. The revocation may be submitted by an Employer or Third Party agent. THIRD PARTY INFORMATION Third Party Name: Third Party Contact: Third Party Contact Phone: Third Party Contact Email: Third Party Address: _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ Third Party FEIN: _______________________________________________________ I am an authorized agent for the Employer, and I hereby designate the above Third Party to conduct business on our behalf. ___________________________________________ Printed Name ___________________________________________ Signature ___________________________________________ Title (Owner, Partner, Officer, etc.) ___________________________________________ Date American LegalNet, Inc. www.FormsWorkFlow.com December 2013 Manual Form 1840