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Power Of Attorney For Department-Administered Tax Matters DR 0145 - Colorado

Power Of Attorney For Department-Administered Tax Matters Form. This is a Colorado form and can be used in General Dept Of Revenue Statewide .
 Fillable pdf Last Modified 8/4/2011
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DR 0145 (03/17/11) COLORADO DEPARTMENT OF REVENUE TAXPAYER SERVICE DIVISION 1375 SHERMAN ST DENVER, CO 80261 www.TaxColorado.com POWER OF ATTORNEY For Department-Administered Tax Matters 7D[SD\HU ,QIRUPDWLRQ DQG ,GHQWL¿FDWLRQ Taxpayers must sign on reverse side. Taxpayer Name(s) and address (include any trade name or DBA) Daytime Phone Number Social Security Number for Individual Second Social Security Number (if using jointly) or Colorado Tax ID Number(s) 2. Representative(s). Representative(s) must sign on reverse side. Hereby appoint(s) the following representative(s) as attorney(s)-in-fact: A. Name(s) and address Phone Number Fax Number Attorney Reg Number or FEIN (if applicable) B. Name(s) and address Phone Number Fax Number Attorney Reg Number or FEIN (if applicable) 3. Tax matters approved for representation: State Sales Tax All Department Administered Sales Taxes State Consumers Use Tax All Dept. Administered Consumers Use Taxes Individual Income Tax Wage Withholding Other Tax (specify) All Taxes within the scope of §39-21-102, C.R.S. Corporate Income Tax Other (specify) Period From ___________ To ___________ Period From ___________ To ___________ Period From ___________ To ___________ Period From ___________ To ___________ Period From ___________ To ___________ Period From ___________ To ___________ $FWV $XWKRUL]HG ² 7KH UHSUHVHQWDWLYHV DUH DXWKRUL]HG WR UHFHLYH DQG LQVSHFW FRQ¿GHQWLDO WD[ LQIRUPDWLRQ DQG UHFRUGV DQG WR SHUIRUP DQ\ DQG DOO acts that the taxpayer named above can perform with respect to the tax matters described in number 3, for example, the authority to sign and bind the taxpayer above to agreements, consents, or other documents. The authority does not include the power to receive refund checks or the deleted DFWV VSHFL¿FDOO\ DGGUHVVHG EHORZ $GGHG RU 'HOHWHG $FWV ² /LVW DQ\ VSHFL¿F DGGLWLRQV RU GHOHWLRQV WR WKH DFWV RWKHUZLVH DXWKRUL]HG LQ WKLV SRZHU RI DWWRUQH\ BBBBBBBBBBBBBBBBBBBBB _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com 5HWHQWLRQ5HYRFDWLRQ RI 3ULRU 3RZHUV RI $WWRUQH\ ² 7KH ¿OLQJ RI WKLV SRZHU RI DWWRUQH\ DXWRPDWLFDOO\ UHYRNHV DOO HDUOLHU SRZHUV RI DWWRUQH\ RQ ¿OH ZLWK WKH &RORUDGR 'HSDUWPHQW RI 5HYHQXH IRU WKH VDPH WD[ PDWWHUV DQG SHULRGV FRYHUHG E\ WKLV GRFXPHQW ,I \RX GR not want to revoke a prior power of attorney, check here .......................................................................................................................................... YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT. 7. Signature of Taxpayer(s) -- If this form is not signed, dated and titled (if applicable), it is invalid. If tax matters concern a joint return, both parties must VLJQ IRU MRLQW UHSUHVHQWDWLRQ ,I VLJQHG E\ D FRUSRUDWH RI¿FHU SDUWQHU JXDUGLDQ WD[ PDWWHUV SDUWQHU H[HFXWRU UHFHLYHU HVWDWH DGPLQLVWUDWRU RU WUXVWHH on behalf of the taxpayer, I certify that I have the authority to execute this form on behalf of the taxpayer. Signature Print Name Signature Print Name Date Title Date Title 'HFODUDWLRQ RI 5HSUHVHQWDWLYH ², DP DXWKRUL]HG WR UHSUHVHQW WKH WD[SD\HUV LGHQWL¿HG LQ QXPEHU IRU WKH WD[ PDWWHUV VSHFL¿HG Signature , UHSUHVHQW WKH WD[SD\HUV LGHQWL¿HG LQ QXPEHU DV Date Title CO-licensed attorney, Reg Number Attorney registered in _____________________ CO-licensed CPA CPA licensed in _________________________ Full-time employee of the taxpayer Enrolled agent __________________________ Other, explain _________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ Signature , UHSUHVHQW WKH WD[SD\HUV LGHQWL¿HG LQ QXPEHU DV Date Title CO-licensed attorney, Reg Number Attorney registered in _____________________ CO-licensed CPA CPA licensed in _________________________ Full-time employee of the taxpayer Enrolled agent __________________________ Other, explain _________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ 3URFHVVLQJ ZLOO EH IDVWHU LI DGGUHVVHG WR D VSHFL¿F VHFWLRQ RI WKH 'HSDUWPHQW DQG LI \RX FDQ DWWDFK FRSLHV RI GRFXPHQWDWLRQ RI WKH LVVXH LQ GLVSXWH VXFK DV D 5HIXQG &ODLP 1RWLFH RI 'H¿FLHQF\ 1RWLFH RI 5HIXQG 'HQLDO )HGHUDO 5HYHQXH $JHQWV 5HSRUW HWF :KHUH WKH DGGUHVV GRHV QRW VSHFLI\ D VHFWLRQ this form will be directed to Taxpayer Service, 1375 Sherman St., Denver, CO 80261. American LegalNet, Inc. www.FormsWorkFlow.com
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