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Georgia Tax Power of Attorney Form 1


Georgia Tax Power of Attorney Form 1
Georgia Tax Power of Attorney Form 1
Section 1 Taxpayer Information
(Taxpayer(s) must sign and date Section 5 of this form)
Taxpayer’s Name
Taxpayer’s Identification Number
Daytime Telephone Number
Spouse’s Name (if joint income tax return)
Spouse’s SSN (if applicable)
Daytime Telephone Number
Mailing Address
Spouse’s Mailing Address (if different from above)
Section 2 Representative Information
(Certain Representative(s) may complete Section 7 of this form) Attach schedule if more than 2.
Name of person given power of attorney
Telephone Number
Fax Number
Mailing Address
State
ZIP Code
Email Address
Name of person given power of attorney
Telephone Number
Fax Number
Mailing Address
City
State
ZIP Code
Email Address
Section 3 Tax Matters
As attorney(s) -in-fact to represent the taxpayer(s) before the Georgia Department of Revenue for the following tax matters [Specify the
type(s) of tax and year(s) or period(s) (date of death if estate tax)]:
Section 4 Retention/Revocation of Prior Power(s) of Attorney
The filing of this power of attorney automatically revokes all earlier power(s) of attorney on file with the Georgia Department of
Revenue for the same matters and years or periods covered by this document. If you DO NOT want to revoke a prior power of
attorney, attach a signed and dated copy of each power of attorney you want to remain in effect and mark an X in this box:
Georgia Department of Revenue
Power of Attorney and Declaration of Representative
Form RD-1061 (Rev. 10/2013)
The attorney(s) -in-fact (or either of them) are authorized, subject to revocation, to receive confidential information and to perform on
behalf of the taxpayer(s) the following acts for the above tax matters [Strike through any of the following which are not granted]:
To receive, but not to endorse and collect, checks in payment of any refund of tax, penalty or interest.
To execute waivers (and related documents) of restrictions on assessment or collection of tax deficiencies and waivers of any other
rights of taxpayer(s).
To execute consents extending the statutory period for assessment, collection or refund of taxes.
To receive all notices pertaining to these tax matters.
To receive confidential information pertaining to these tax matters.
To delegate authority or to substitute another representative.
To do
all the lawful acts and things whatsoever concerning these tax matters in every respect as taxpayer(s) could do were taxpayer(s)
personally present at the doing thereof.
To represent taxpayer(s) in conferences and hearings, to file appeals from notices of assessment, and to execute claims for refund.
Other acts [Specify]:
(Submit this form through GTC or to the Department Division which is handling your inquiry)
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Georgia Tax Power of Attorney Form 1
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