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Maine Limited Power of Attorney Form


Maine Limited Power of Attorney Form
Maine Limited Power of Attorney Form
LIMITED POWER OF ATTORNEY FORM
Name of AIF (print): _________________________________________________
Address of AIF: _________________________________________________
Ph. Number : _________________________________________________
Tax Type: _________________________ Tax Period:______________
Name of Taxpayer (print):___________________________________________________
Date of Birth: __________________________
Social Security Number/Tax ID Number : _____________________________________
Address of Taxpayer : _________________________________________________
Ph. Number : _________________________________________________
______________________________________________ _________________________
Taxpayer Signature, Title Date
NOTICE: This form does NOT revoke other power of attorney forms on le with MRS.
Please read, ll out, and sign this form if you wish to appoint an attorney-in-fact (“AIF”). Your
tax record information kept by MRS is con dential by law. This includes all returns and lings
made by you. This form allows MRS to discuss your tax record information with your AIF. Your
tax records are all your tax information on le with MRS.
I understand that my tax records are con dential under State law.
I authorize my named AIF to discuss information in my tax records with MRS.
I authorize MRS to discuss information in my tax records with my named AIF.
Revised 06/11
STATE OF MAINE
MAINE REVENUE SERVICES
24 STATE HOUSE STATION
AUGUSTA, MAINE 04333-0024
Maine Limited Power of Attorney Form