Home > Legal > Legal > Power of Attorney Template > Alaska Power of Attorney Form > Alaska Company's Power of Attorney Template

Alaska Company's Power of Attorney Form

At Speedy Template, You can download Alaska Company's Power of Attorney Form . There are a few ways to find the forms or templates you need. You can choose forms in your state, use search feature to find the related forms. At the end of each page, there is "Download" button for the forms you are looking form if the forms don't display properly on the page, the Word or Excel or PDF files should give you a better reivew of the page.

Alaska Company's Power of Attorney Form
Alaska Company
Employment Security Division Unemployment Insurance (UI) Tax
1111 W. 8
Street, P.O. Box 115509, Juneau, AK 99811-5509
1-888-448-3527 or (907) 465-2757, Fax: (907) 465-2374;
TTY/TDD: 1-800-770-8973 or E-mail address: esd_tax@labor.state.ak.us
That________________________________________________ UI Account No. _______________
(business name)
Federal ID No. ________________having its principal office at __________________________________________
(business mailing address)
City State Zip Code
does hereby constitute and appoint __________________________________________________________
(designated authority)
(designated authority mailing address)
City State Zip Code
Phone Fax
its true and lawful attorney in fact with full power and authority to represent said company before the Alaska
Department of Labor and Workforce Development, Employment Security Division effective immediately and until
this authority has been revoked in writing in connection with any and all unemployment insurance matters as
indicated below:
[ ]
1. Filing of completed forms, including claims for refund or adjustment of account, liability or status
determinations and wage record reports.
[ ] 2. Receipt of blank Quarterly Contribution Report Form (TQ01)
[ ] 3. Receipt of Tax Rate Notices (TR02)
[ ] 4. Payment of contributions and any penalties and interest assessed on the account.
[ ] 5. Discuss matters affecting the experience record and contribution rate of the employer account.
[ ] 6. Discuss all matters affecting any adjustments to the employer’s account.
[ ] 7. All matters and forms affecting UI benefits, job separation information, hearing notices and decisions.
IN WITNESS WHEREOF, the said________________________________________________________
(owner, officer or member)
has caused this instrument to be duly attested by the signature of its duly qualified officer this__________ day
of_____________________, 20____. This authorization cancels and supersedes all prior authorizations for
authority indicated in areas 1 through 7 above.
Company Name:
( employer signature):
STATE:______________ COUNTY OF_____________________________, _________________, 20______
Then, personally appeared the above named____________________________________________ whose
title is____________________________________ and acknowledged the foregoing instrument to be his/her free
act and deed in his/her said capacity.
Notary Public
Type or Print Name
My Commission Expires
rev 05/12)
Alaska Company's Power of Attorney Form