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Iowa Unemployment Insurance And Tax Power of Attorney Form

The Iowa unemployment insurance and tax power of attorney is a legal document used by the employer to authorize the attorney-in-fact to act on his/her behalf in the company's unemployment insurance, claims/benefits and tax related matters.

Iowa Unemployment Insurance And Tax Power of Attorney Form
Iowa Unemployment Insurance And Tax Power of Attorney Form
ACCOUNT NUMBER
FORM NUMBER
68-0092
DOCUMENT CONTROL DATE
DESCRIPTION (CONTINUED)
FOR ADMINISTRATIVE
USE ONLY
DESCRIPTION
000
IOWA WORKFORCE DEVELOPMENT UNEMPLOYMENT INSURANCE (UI) TAX BUREAU
Declaration of Power of Attorney or Authorized Representative - 68-0092 (05-07)
1. Provide Employer/Company Information
Legal Name of Business or Last Name of Sole Proprietor
First Name of Sole Proprietor Initial
Social Security Number
Iowa UI Tax Account Number
DBA Name
Current Mailing Address
Telephone Number
City
State
Zip Code + 4
Employer's E-Mail Address
Federal Identification Number
2. Provide Power of Attorney or Authorized Representative Information
Name of Firm or Company's Legal Name
Name (if Firm is not designated)
Address
Telephone Number Fax Number
Employer's E-Mail Address of Power of Attorney or Authorized Representative
Check appropriate box. Refer to instructions for explanation of privileges.
Power of Attorney Authorized Representative
As the true and lawful agent, with limited power and authority to represent the said employer before Iowa Workforce Development, until further notice, in only
the matters selected below: (Please check all pertinent boxes)
All Unemployment Insurance matters All Tax related matters
All Claims/Benefits related matters.
Filing - Unemployment Insurance Reports and payments
State
City
Federal Identification Number
Zip Code + 4
Iowa Unemployment Insurance And Tax Power of Attorney Form
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