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Georgia Employee Leasing Company's Power of Attorney Form


Georgia Employee Leasing Company's Power of Attorney Form
Georgia Employee Leasing Company
GEORGIA, COUNTY
GA DOL ACCOUNT NO.
FOR DEPARTMENT USE ONLY
EMPLOYEE LEASING COMPANY’S
POWER OF ATTORNEY
WHEREAS, , an employer liable under
the Employment Security Law, has elected under OCGA Section 34-8-32 and 34-8-172 of the Employment Security Law
and Offi cial Rule 300-2-7-.07 to treat and report all leased employees as its own employees and to prepay unemployment con-
tributions monthly; and
WHEREAS, this employer has further elected under OCGA Section 34-8-172 of the Employment Security Law to deposit
acceptable securities in lieu of either the cash deposit or surety bond required by this Code Section; and
WHEREAS, , has purchased in its own
name
of total value of $ for the purpose of substituting for the above described cash deposit or
surety bond; and
WHEREAS, these securities along with a copy of this Power of Attorney properly executed will be deposited
in the
for safekeeping.
NOW, THEREFORE, pursuant to the terms of the Employment Security Law:
KNOW ALL MEN BY THESE PRESENTS, that the undersigned offi cer of the
,pursuant to authority granted him or her to act
on behalf of , hereby constitutes and
appoints the Georgia Department of Labor the true and lawful Attorney in Fact for
to act in its place and stead, as follows:
In the event of default by , the
Attorney in Fact is hereby authorized and empowered to give notice of redemption of the subject Security to the obligor Bank in
writing and pursuant to the terms of the Security and the Rules and Regulations of their issue, upon receipt of which notice of
redemption the obligor Bank shall be authorized and directed to redeem said Security pursuant to the terms thereof and to pay
all sums due thereunder directly to the Georgia Department of Labor for application by that Department.
DOL-14B (R-5/08)
(employer)
(employer)
(employer)
(employer)
(Give full description of Security)
(employer)
(Name and Address of Bank)
(employer)
Georgia Employee Leasing Company's Power of Attorney Form
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