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Mississippi Tax Power of Attorney Form

The Mississippi 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.

Mississippi Tax Power of Attorney Form
Mississippi Tax Power of Attorney Form
POWER OF ATTORNEY and
DECLARATION of REPRESENTATION
21-002-08
MAIL TO: MS Department of Revenue P.O. BOX 1033 JACKSON, MS 39215-1033 PHONE: 601-923-7000
PART I POWER OF ATTORNEY
Taxpayer(s) Information
For DOR Use Only
Name _____________________
Bureau _____________________
Phone _____________________
Date
_________________
Taxpayer Name(s) and Mailing Address Taxpayer Social Security Number
Spouse Social Security Number
Federal ID Number (FEIN)
Hereby appoint(s) the following representative
Representative Information
Name and Mailing Address
Phone Number ________________________________________________________________
FAX Number __________________________________________________________________
Name and Mailing Address
Phone Number ________________________________________________________________
FAX Number __________________________________________________________________
Name and Mailing Address
Phone Number ________________________________________________________________
FAX Number __________________________________________________________________
To represent the taxpayer(s) before the Mississippi Department of Revenue (“Department”)
Tax Matters
Tax Type (Income, Franchise, Sales, Insurance Premium, etc.) Account Number Tax Period(s)
Acts Authorized
The representatives are authorized to receive and inspect confidential tax information and to perform any and all acts that
I (we) can perform with respect to the matters concerning the taxes and accounts described under Tax Matters above, for
example, the authority to sign any agreements, consents or other documents and to represent the taxpayer(s) in any
informal or formal proceeding involving the Department. The authority of the representatives does not and cannot include
the power to substitute another representative or to request that tax return(s) or other confidential tax information of the
taxpayer(s) be inspected by or disclosed to another person. The authority also does not include the authority to receive
tax refund checks or to sign returns unless specifically added below.
List any specific additions or deletions to the acts otherwise authorized by this power of attorney:
Additions: ____________________________________________________________________________________
Deletions: ____________________________________________________________________________________
The Department may reject a submission due to incompleteness, lack of specificity, or inappropriateness.
Retention/revocation of Prior Power(s) of Attorney
The filing of this Power of Attorney automatically revokes all earlier Power(s) of Attorney on file with the Department for
the same tax matters and tax periods covered by this document. If you do not want to revoke a prior Power or Attorney,
check here and ATTACH A COPY OF THE POWER(S) OF ATTORNEY YOU WANT TO REMAIN IN EFFECT.
Mississippi Tax Power of Attorney Form
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