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Minnesota Tax Power of Attorney Form

The Minnesota 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.

Minnesota Tax Power of Attorney Form
Minnesota Tax Power of Attorney Form
I appoint the following as attorney-in-fact to represent me before the Minnesota Department of Revenue. I understand it is my responsibility
to keep my appointee informed of my tax matters and of any matters relating to my nontax debts that have been referred to the department
for collection. I also understand that the department does not send copies of all correspondence to my appointee. (For exception, see “Elec-
tion” below.)
Name of person (appointee) given power of attorney Name of rm (if applicable)
Street address City State Zip code
Phone number FAX number
The appointee is authorized to provide and receive private and nonpublic information concerning my state taxes and my nontax debts re-
ferred to the department for collection, and:
I grant full authority to the appointee. The appointee is authorized to perform any and all acts I can perform with respect to my tax mat-
ters and to my nontax debts referred to the Department of Revenue for collection.
Check this box if the appointee is not authorized to sign tax returns.
Igrantlimitedauthorityforspecictaxtypes,periodsand/orduties.Check only the boxes that apply. By checking the boxes, the ap-
pointee will be authorized to perform acts on your behalf with respect to only the indicated tax matters. If a specic year or period is not
indicated for a selected tax type, the powers granted will apply to all years and/or periods, both past and future:
Check this box if the appointee is not authorized to sign the return(s) for the tax matters indicated below.
Taxtype Year(s)orperiod(s) Taxtype Year(s)orperiod(s)
Individual income tax Sales and use tax
Property tax refund Withholding tax
Partnership tax S corporation tax
MinnesotaCare taxes Corporation franchise
Fiduciary income tax Nontax debt matters
Other (please specify):
Comments:
Electionforappointeetoreceiveallcorrespondence,includingrefunds,fromthedepartment. If you make this election, you will no longer
receive anything—including refunds, legal notices and correspondence—from the department, and your appointee will receive it all on your
behalf. To make this election, complete and attach Form REV184a to this form.
Taxpayer’s name Social Security or Minnesota tax ID number (or federal ID number)
Spouse’s name (if a joint return) Spouse’s Social Security number (if a joint return)
Street address
City State Zip code
Expirationdate Month Day Year
(If a date is not provided, this power
of attorney is valid until revoked.)
Print or Type
Original—your rst power of attorney
authorizing this appointee
Amend—changes an existing power of
attorney for this appointee
Cancel/Revoke—cancels a previously
led power of attorney
Checkone
(see instructions):
Power of Attorney
Read the instructions on the back before completing this form.
REV184
Power of Attorney
(Rev. 9/11)
The power of attorney is not valid until it is signed and dated.
Taxpayer’s signature or signature of corporate ofcer, partner or duciary Print name (and title, if applicable) Date Phone
Spouse’s signature (if joint) Print spouse’s name (if joint) Date Phone
SubmitasignedcopyofthisPowerofAttorneytotheDepartmentofRevenueusingoneofthefollowingmethods:
• AttachinasecureemailtoMNDOR.PO[email protected];
• FAXto651-556-5210;OR
• MailtoMinnesotaRevenue,MailStation4123,St.Paul,MN55146-4123
Sign Here Election
Minnesota Tax Power of Attorney Form
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