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Colorado Tax Information Designation and Power of Attorney for Representation Form

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Colorado Tax Information Designation and Power of Attorney for Representation Form
Colorado Tax Information Designation and Power of Attorney for Representation Form
DR 0145 (12/09/13)
COLORADO DEPARTMENT OF REVENUE
Taxation Business Group
Denver, CO 80261-0009
www.TaxColorado.com
Tax Information Designation and
Power of Attorney for Representation
Office Use Only
Date Received:
Taxpayer Last Name or Business Name First Name Middle Initial SSN, CAN or FEIN
Spouse’s Last Name, if returns are filed jointly First Name Middle Initial SSN or CAN
Address City State Zip
Mark only one (the department will accept the federal form 2848, Power of Attorney and Declaration of Representative, in lieu of this document):
Tax Information Authorization: Marking this box allows the
department to disclose your confidential tax information to
your designee. You may designate a person, agency, firm or
organization. See Section 39-21-113 (4) (b).
Power of Attorney for Representation: Mark this box if you want
a person to “represent” you. This means the person may receive
confidential information and may make tax decisions on your behalf.
For All Tax years or
Specific tax years/filing periods:
I hereby appoint the following person as Designee for Tax Information or Attorney for Representation:
Last Name First Name Middle Initial
Mailing Address Phone Number
( )
City State Zip Fax Number
( )
Name of business/firm (if applicable)
Representative’s title or relationship to taxpayer
Last Name First Name Middle Initial
Mailing Address Phone Number
( )
City State Zip Fax Number
( )
Name of business/firm (if applicable)
Representative’s title or relationship to taxpayer
The above-named is authorized to receive my confidential information and/or represent me before the Colorado
Department of Revenue for:
All tax matters until this authorization is revoked in writing, or
Specific tax matters as follows (mark all that apply):
*130145==19999*
Colorado Tax Information Designation and Power of Attorney for Representation Form
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