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Indiana Tax Power of Attorney Form 2


Indiana Tax Power of Attorney Form 2
Indiana Tax Power of Attorney Form 2
Indiana Department of Revenue
POWER OF ATTORNEY
1. Taxpayer Information
Taxpayer(s) Name(s)
DBA Name(s) (if applicable)
Address New Address
City State Zip Code
Telephone Number
2. Identication Numbers
Indiana Taxpayer Identification Number (10 digits) or Employer Identification Number
Social Security Number Spouse’s Social Security Number
Hereby appoint(s) the following:
3. Representative Information
Individual Representative Name
Additional Individual Representative Name
Address Address
City State Zip Code City State Zip Code
Telephone Number Email Telephone Number Email
Additional Individual Representative Name Additional Individual Representative Name
Address Address
City State Zip Code City State Zip Code
Telephone Number Email Telephone Number Email
4. Firm/Vendor Information
Firm/Vendor Name (if applicable)
Address
City State Zip Code
Telephone Number Email
POA - 1
State Form 49357
(R5 / 2-14)
Indiana Tax Power of Attorney Form 2
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