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Rai?uffii8@ Woshrngton Saote Tax and License Secrecy Clause Confidentiality Ag reem ent This form mus_t be completetl_and signed by individuals with access to Confidential lnformation in the custody andcontrol of the Department of Revenue, and approved by the appropriate designated authority. tdentification: Name: BRIAN CARLSON 11119. BUDGET & FINANCE DIRECTOR Employe r: KITTITAS COUNTY Phone:(509) 962-7502 Address:205 W Sth Ave -r",,. brian.carlson@co.kiftitas.wa. us City, State, Zip:Eltensburg WA 98926 Scope: Department of Revenue Confidential lnformation covered by this agreement includes: . Licensing information (RCW 19.02.11S) r Personally identifying information (RCW 42.56.590) ' Property tax information (RCW 84.08.210, Rcw 84.40.020, Rcw 84.40.340) r Tax information (RCW S2.32.330) r Federaltax information (26 USC 6103) r Unclaimed Property (RCW 63.29.380) . Confidential organizational and other information exempt by law Acknowledgement of confidentiality: I have read and understand the following obligations and responsibilities; fumay use.and.access Confidential lnformation for official purposes only as needed to conduct businesst"iiEii and tt applicable, as authorized by the data sharing agreement with my employer. Wly:y,l-oj-ut9t publish, transfer, sell or otherwise disclose any Confidential lnformation acquired for anyvtr.rrrrl- UnOUthOfized pUrpoSe. fu^r"t protect the information and maintain reguired security safeguards. 'M must maintain confidentiality afler I no longer have access to the information. Myllylgl?lYh" discloses confidential.tax or licensing information to an unauthorized person is guitty ofmisdemeanor' A-state employee is subject to loss of position and inability to hold pubiic employi1eni inWashington State for two years. Additional penalties may apply under state or federal laws. See RCW82.32.330(6) and 1e.02.1 1 S(5) I certify under penalty of perj the laws of the state of Washington that the is true and correct. Signature:Date Signed Authorization (to be completed I authorize the individual above to following business requirements: by employer): have access to Department of Revenue confidential lnformation to meet the Name: Signature: Authority: Title: Date:2 pervisor {contract Manager n Agency Security Administrator tr other: For lax asslslance or to request lhis document in an atternate fomat, ptease catt 360-705-670s. Tetetype (TTy) users may use the washinglon RelaySeNice by calling 711. REV 10 0A32e (6/25/19l