Tax Power of Attorney

Tax Power of Attorney

Taxpayer Name:

Taxpayer Identification

Address:

Individual/Sole Proprietor    C Corp    S Corp    Partnership    Trust/Estate    LLC    Other

Taxpayer Identification Number (TIN)

Social Security Number (if individual):

Employer Identification Number (if applicable):

(Complete only one of the above identification numbers that applies to the taxpayer.)

Representative (Attorney-in-Fact)

Scope of Authority

The taxpayer appoints the representative named above as attorney-in-fact to represent the taxpayer in all tax matters specified below. The representative is authorized to perform any and all acts that the taxpayer can perform with respect to the matters described, including but not limited to the following:

1. Receive and inspect confidential tax information and tax return information.
2. Sign consents, waivers, closing agreements, and other documents necessary to represent the taxpayer for the specified matters.
3. Represent and act for the taxpayer in examinations, appeals, conferences, hearings, and proceedings before administrative bodies and in collection matters.
4. Execute and file powers of attorney, waivers, and other instruments required to accomplish the above authority.
5. Substitute another representative and delegate authority as necessary unless explicitly restricted by the taxpayer in Section: Special Instructions.

Income Taxes    Employment Taxes (Payroll)    Excise Taxes    Collection Matters (Liens, Levies)    Return Preparation & Filing    Other

Duration and Revocation

This power of attorney becomes effective on the date signed below and remains in effect until revoked in writing by the taxpayer or until the expiration date noted below. Unless an expiration date is provided, this instrument remains in effect until revoked.

Revocation of prior powers of attorney: By checking this box, the taxpayer revokes any prior power(s) of attorney relating to the tax matters identified above for the periods specified herein.

Special Instructions / Limitations

Certification and Authorization

Under penalties of perjury, I certify that I am the taxpayer or an authorized officer, partner, fiduciary, shareholder, or other person authorized to execute this power of attorney on behalf of the taxpayer. I further certify that the information provided on this form is true, correct, and complete to the best of my knowledge.

1. The representative is authorized to receive and inspect confidential tax information relating to the matters described in this document.
2. The representative has authority to perform all acts necessary to represent the taxpayer, except as limited by the Special Instructions above.
3. This power of attorney does not authorize the representative to perform acts that the taxpayer cannot lawfully delegate, nor to endorse or negotiate taxpayer checks unless expressly authorized.
4. Taxpayer understands that this designation may result in disclosure of confidential tax information to the representative and that the representative’s authority may be revoked by written notice.

Acceptance by Representative (Optional)

The representative named above acknowledges and accepts the appointment, and agrees to represent the taxpayer in accordance with the terms and limitations of this power of attorney.

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