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Louisiana Tax Power of Attorney Form

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The Louisiana tax power of attorney is a legal document used by the grantor to authorize the attorney-in-fact to act on his/her behalf in his/her tax related matters.

Louisiana Tax Power of Attorney Form Page 2
Louisiana Tax Power of Attorney Form
NOTICES AND COMMUNICATIONS. Original notices and other written communications will be sent only to you, the taxpayer. Your representa-
tive may request and receive information by telephone, e-mail or fax. Upon request, the representative may be provided with a copy of a notice
or communication sent to you. If you want the representative to request and receive a copy of notices and communications sent to you, check
this box.
REVOCATION OF PRIOR POWER(S) OF ATTORNEY. Except for Power(s) of Attorney and Declaration of Representative(s)led on Form
R-7006 (1/11), the ling of this Power of Attorney automatically revokes all earlier Power(s) of Attorney on le with the Louisiana Department
of Revenue for the same tax matters and years or periods covered by this document.
Signature of Taxpayer(s). If a tax matter concerns a joint return, both husband and wife must sign if joint representation is requested.
If signed by a corporate officer, partner, guardian, tax matters partner, executor, receiver, administrator, or trustee on behalf of the tax-
payer, I certify that I have the authority to execute this form on behalf of the taxpayer.
IF THIS POWER OF ATTORNEY IS NOT SIGNED AND DATED, IT WILL BE RETURNED.
_____________________________________________________________________________________
____________________
Taxpayer signature Date
_____________________________________________________________________________________ ____________________
Spouse signature Date
_________________________________________________ __________________________________ ____________________
Signature of duly authorized representative, if the taxpayer Title Date
is a corporation, partnership, executor or administrator
Part II. DECLARATION OF REPRESENTATIVE
Under penalties of perjury, I declare that:
• IamnotcurrentlyundersuspensionordisbarmentfrompracticebeforetheInternalRevenueService.
• Iamauthorizedtorepresentthetaxpayer(s)identiedinPartIforthetaxmattersspeciedthere;and
• Iamoneofthefollowing:(insert applicable letter in table below)
a. Attorney—a member in good standing of the highest court of the jurisdiction shown below.
b. Certied Public Accountant—duly qualied to practice as a certied public accountant in the jurisdiction shown below.
c. Enrolled Agent—a person enrolled to practice before the Internal Revenue Service.
d. Officer—a bona de officer of the taxpayer organization.
e. Employee—an employee of the taxpayer.
f. Family Member—a member of the taxpayer’s immediate family (state the relationship, i.e., spouse, parent, child, brother, or sister).
_____________________________________________________________________________.
g. Other (state the relationship, i.e., bookkeeper or friend) ________________________________________________.
h. Former Louisiana Department of Revenue Employee. As a representative, I cannot accept representation in a matter with which I
had direct involvement while I was a public employee.
IF THIS DECLARATION OF REPRESENTATIVE IS NOT SIGNED AND DATED, THE POWER OF ATTORNEY WILL BE RETURNED.
Designation-Insert
Above Letter (a-h)
State
Issuing
License
State License Number Signature Date
R-7006 (1/11) Page 2
Louisiana Tax Power of Attorney Form
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