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Idaho Tax Power of Attorney Form 1


Idaho Tax Power of Attorney Form 1
Idaho Tax Power of Attorney Form 1
EFO00104 02-13-14
Idaho State Tax Commission
Power of Attorney
1. TAXPAYER/GRANTOR INFORMATION
2. REPRESENTATIVE(S) - For multiple representatives, attach additional sheets.
Check here if you dont want the representative to receive copies of notices and communications:
3. TAX MATTERS APPROVED FOR REPRESENTATION
The above representative is hereby appointed as attorney-in-fact to represent the taxpayer/grantor(s) before the Idaho State Tax Commission for the
following tax or fee matter(s). You must identify the tax or fee type, permit number (if applicable), and specific periods/years.
*Tax or Fee Types *State Tax/Fee Permit Number *Periods/Years
(Required if applicable) (Must include beginning and ending date)
Individual income tax
Business income tax
Sales & use tax
Income tax withholding
Other tax/fee (specify)
______________________________
4. ACTIONS AUTHORIZED
The representative(s) are generally authorized to receive and inspect confidential tax or fee information and records, perform any and all actions that the
taxpayer/grantor(s) named above can perform with respect to the specified tax or fee matters listed. The authority doesnt include the power to receive
refund checks.
Added or deleted actions - List any specific additions or deletions to the actions otherwise authorized in this Power of Attorney:
_________________________________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
5. REVOCATION/EXPIRATION
The filing of this Power of Attorney (POA) automatically revokes all prior POAs on file with the Idaho State Tax Commission for the same matters and
years authorized in this document.
Check here if you dont want to revoke prior POA(s): Expiration date (optional): _____________________________
6. SIGNATURE OF TAXPAYER/GRANTOR(S)
All parties identified in Section 1 MUST sign.
If signed by a corporate officer, partner, guardian, tax matters partner, executor, receiver, administrator, or trustee on behalf of the taxpayer/grantor: I
certify that I have the authority to execute this form.
*Name Title (If applicable) Date
*Name Title (If applicable) Date
*
Required Information. This form is valid only if all information is complete. An incomplete form will be returned to you.
*Taxpayer/Grantor’s last name or Company’s name
* Taxpayer/Grantor’s first name/middle initial
* Taxpayer/Grantor’s SSN or EIN
*Spouse’s last name
*Spouse’s first name/middle initial
*Spouse’s SSN
*Address
Daytime telephone number
*City, State, Zip
Email address
*Name
PTIN, EIN or SSN
*Firm or company’s legal name
Telephone number
*Address
Fax number
*City, State, Zip
Email address
Idaho Tax Power of Attorney Form 1
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