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North Carolina Tax Power of Attorney Form

The North Carolina 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.

North Carolina Tax Power of Attorney Form
North Carolina Tax Power of Attorney Form
GEN-58
Power of Attorney
and Declaration of Representative
North Carolina Department of Revenue
P. O. Box 25000, Raleigh, NC 27640-0005
Fax: 919-715-1786
Power of Attorney (Please type or print.)
1 Taxpayer Information (Taxpayer(s) must sign and date this form on page 2, line 7.)
Part 1.
Taxpayer name(s) and address
Social security number(s) Fed Employer ID Number
Daytime telephone number
hereby appoint(s) the following representative(s) as attorney(s)-in-fact:
2
Representative(s)
(Representative(s) must sign and date this form on page 2, Part 2.)
to represent the taxpayer(s) before the North Carolina Department of Revenue for the following matters:
3
Tax Matters You may list any tax years or periods that have already ended as of the date you sign the power of attorney. You may include future tax
years or periods that end no later than 3 years after the date the power of attorney is received by the Department of Revenue.
4 A
cts Authorized. - The representatives are authorized to receive and inspect condential tax information, which may include federal tax information, and
to perform any and all acts that I (we) can perform with respect to the tax matters described on line 3, for example, the authority to sign any agreements,
consents, or other documents. For purposes of this section, federal tax information is dened as federal tax returns and return information received
from the Internal Revenue Service.
Web-Fill
7-12
Type of Tax (Individual, Corporate, Sales, etc.) Year(s) or Period(s)
List any specic additions or deletions to the acts otherwise authorized in this power of attorney:
Name and address
Name and address
Name and address
Fax No.
Telephone No.
Fax No.
Telephone No.
Fax No.
Telephone No.
4
PRINT
CLEAR
North Carolina Tax Power of Attorney Form
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