Taxpayer Appointment Resolution Form

TAXPAYER APPOINTMENT RESOLUTION FORM

Entity Identification

Taxpayer/Entity Name:

Employer Identification Number (EIN) or SSN:

Corporation    Limited Liability Company (LLC)    Partnership    Trust    Individual/Sole Proprietor    Other:

Resolution of Authority

At a meeting duly called and held, or by unanimous written consent of the governing body of the taxpayer on , the following resolution was adopted and is now in full force and effect:

RESOLVED: That the taxpayer hereby appoints and authorizes the individual and/or firm named below to act as the taxpayer's authorized representative with respect to tax matters described herein, and to take any and all actions necessary or incidental to such representation as set forth in this resolution.

Phone:    Email:

Scope of Authority

The authority granted to the appointed representative includes, but is not limited to, the following actions (check all that apply and specify limitations where indicated):

Represent the taxpayer before tax authorities and administrative tribunals with respect to tax matters.
Receive and inspect confidential tax information and transcripts.
Prepare, execute and file tax returns, consents, extensions, agreements, waivers, and other tax-related forms on behalf of the taxpayer.
Sign tax returns or other documents under penalties of perjury where permitted by law.
Negotiate and enter into settlement agreements, installments, or offers in compromise subject to prior written approval by the taxpayer:
Substitute or appoint other authorized representatives to perform the functions granted herein.
Other authority:

Income Tax    Employment/Payroll Tax    Sales/Use Tax    Excise Tax    Other:

All tax years and periods prior to and including the date of this appointment.
Specific tax years/periods:

This appointment shall remain in effect until revoked in writing by the taxpayer or as otherwise limited herein. Revocation shall not affect actions taken by the representative prior to receipt of written revocation.

Limitation of Authority and Instructions

Certification of Secretary or Authorized Officer

I hereby certify that I am the duly elected or appointed and acting Secretary or other authorized officer of the taxpayer named above; that the foregoing is a true and correct copy of a resolution duly adopted by the governing body of the taxpayer; that said resolution is in full force and effect on the date hereof; and that the authority granted by this resolution has not been modified, rescinded, or superseded.

Date of Certification:

Acknowledgment and Miscellaneous Provisions

The taxpayer acknowledges that the appointed representative may access sensitive and confidential tax information. The taxpayer agrees to hold the representative harmless for actions taken within the scope of this appointment and acknowledges that the representative is authorized to act in reliance upon this resolution until written revocation is delivered.

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