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Alaska Tax Power of Attorney Form


Alaska Tax Power of Attorney Form
Alaska Tax Power of Attorney Form
Alaska
Power of Attorney
775_
POA
0405-775_POA Rev 08/12 - page 1
775_
POA
EIN Telephone Number
SSN
Taxpayer Name Fax Number
Mailing Address City State Zip
INDIVIDUAL PARTNERSHIP CORPORATION LIMITED LIABILITY CORPORATION
OTHER
I hereby appoint: [enter below the names(s), addresses (including zip codes), telephone numbers and facsimile numbers of
individual appointee(s). Appointees must sign the declaration on page 2.]
Appointee Name(s) Appointee Name(s)
Appointee Firm Appointee Firm
Appointee Address Appointee Address
City State Zip City State Zip
Telephone Number Fax Number Telephone Number Fax Number
as attorney-in-fact to represent the taxpayer with respect to the following Alaska tax matters [specify each type of tax and year or period]:
The attorney-in-fact shall, subject to revocation, have authority to receive condential information and full power and authority to
perform on behalf of the taxpayer all acts with respect to the above tax matters except as follows:
(Strike through any of the following powers which are not granted.)
To represent the taxpayer in administrative proceedings.
To receive, but not to endorse and collect, checks in payment of any refund of Alaska Department of Revenue taxes, penalties, or
interest.
To execute waivers (including offers of waivers) of restrictions on assessment or collection of deciencies in tax and waivers of
notice of disallowance of a claim for credit or refund.
To execute consents extending the statutory period for assessment or collection of taxes.
To execute closing agreements and stipulations.
To delegate authority or to substitute another representative.
Other powers not granted: (Specify)
Assessments and decisions in proceedings involving the above matters should be sent to (Check one)
Taxpayer Attorney-in-fact
This power of attorney revokes all prior powers of attorney led with respect to the same matters and years or periods covered by this
instrument, except the following (Specify and attach copies of the powers of attorney)
Signature of Taxpayer If signed by a corporate ofcer, partner, or duciary on behalf of the taxpayer, I certify that I have the authority to execute this
power of attorney on behalf of the taxpayer.
Signature Title, If Applicable Date
Printed Name Printed Title
THE ORIGINAL MUST BE FILED WITH THE DEPARTMENT
Alaska Tax Power of Attorney Form
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