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The Louisiana tax power of attorney is a legal document used by the grantor to authorize the attorney-in-fact to act on his/her behalf in his/her tax related matters.
Power of Attorney and Declaration
PART I. POWER OF ATTORNEY
Taxpayer(s) must sign and date this form on page 2. PLEASE TYPE OR PRINT.
Your Name or Name of EntitySpouse’s name, if a joint return (or corporate officer, partner or duciary, if a business)
Social Security/Louisiana or Federal ID NumberSpouse’s Social Security Number (if a joint return)
I/we appoint the following representative as my/our true and lawful agent and attorney-in-fact to represent me/us before the Louisiana
Department of Revenue. The representative is authorized to receive and inspect condential information concerning my/our tax matters,
and to perform any and all acts that I/we can perform with respect to my/our tax matters, unless noted below. Modes of communica-
tion for requesting and receiving information may include telephone, e-mail, or fax. The authority does not include the power to
receive refund checks, the power to substitute another representative, the power to add additional representatives, or the power
to execute a request for disclosure of tax returns or return information to a third party.
Representative must sign and date this form on page 2, Part II.
Acts Authorized. Mark only the boxes that apply. By marking the boxes, you authorize the representative to perform any and all acts on
your behalf, including the authority to sign tax returns, with respect only to the indicated tax matters:
Tax Type Year(s) or Period(s) Tax Type Year(s) or Period(s)
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