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Power Of Attorney POA-1 - Indiana
| Power Of Attorney Form. This is a Indiana form and can be used in Aircraft Department Of Revenue Statewide . |
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POA - 1 1) State Form 49357 (R3 / 1-13) Indiana Department of Revenue POWER OF ATTORNEY (Instructions on Back) 2) Indiana Taxpayer Identification Number Taxpayer(s) Name(s) D\B\A Name(s) Employer Identification Number Address City State Telephone # Hereby appoint(s) the following : 3) Individual Representative Name Address City Telephone # 4) Firm/Corp. Name (If applicable) Address City Telephone # 5) State Zip Code If Firm or Corp. list Representative(s) Name a) b) c) d) Tax Form Number (IT-40, WH-3, ST-103, etc.) __________________________ __________________________ __________________________ Year(s) / Period(s) ________________________ ________________________ ________________________ State Email Zip Code Additional Individual Representative Name Address City Telephone # State Email Zip Code Zip Code Spouse's Social Security Number Social Security Number Type of Tax (Income, Withholding, Sales, etc.) ____________________________ ____________________________ ____________________________ 6) I acknowledge that the designated representative has the authority to receive confidential information and full power to perform on behalf of the taxpayer in tax matters related to this Power of Attorney. This authority does not include the power to receive refund checks. I acknowledge that actions taken by the designated representative are binding, even if the representative is not an attorney. Proceedings cannot later be declared legally defective because the representative was not an attorney. If I am a corporate officer, partner or fiduciary acting on behalf of the taxpayer, I certify that I have authority to execute this Power of Attorney on behalf of the taxpayer. 7) Signature _________________________________________________ Printed Name______________________________________________ Telephone # _______________________________________________ Date _______________________________ Title _______________________________ Email ______________________________ American LegalNet, Inc. www.FormsWorkFlow.com Instructions for Indiana Form POA-l Casual conversations with a taxpayer's representative, who does not have a Power of Attorney on file, are permitted. However, neither tax return information nor taxpayer-specific information will be disclosed to the representative unless a properly executed Power of Attorney has been filed with the Indiana Department of Revenue. You can also authorize the Department to discuss information about your tax return with someone else by filling out the Personal Representative portion of the individual tax return. Pursuant to 45 IAC 15-3-4, a properly executed Power of Attorney must contain the following information. 1. The taxpayer's name, D\B\A name, address and telephone number 2. The Indiana taxpayer's identification number (TID). The TID number is assigned by the Indiana Department of Revenue; each entity has its own TID number. The employer identification number (EIN) is a number provided by the Internal Revenue Service. Individual taxpayers should use their Social Security Numbers unless they have been issued a TID number. 3. Enter the name, address and telephone number of your individual representative(s). Only individuals may be named as representatives. If you want to add one additional individual representative, indicate so in the space provided. If you want to add more than one additional individual representative, indicate so in the space provided and attach a list of additional representatives to the form. 4. If your representative works for a firm or corporation, enter the name, address and phone number of the company. Enter the individual name of your representative(s). Only individuals may be named as representatives. If you want to add more than four individual representatives for a firm or corporation, indicate so in the space provided and attach and sign a list of additional representatives to the form. 5. The Power of Attorney form must contain the specific type of tax, tax form number(s) and the specific tax years for which the individual representative has been appointed. A Power of Attorney form listing "all" or "any" (or a similar designation) for a type of tax, tax form number, and/or tax years will not be accepted by the Department. 6. Include as an attachment any restrictions or limitations which the taxpayer has placed on the representative while acting as the taxpayer's representative. 7. The Power of Attorney form must be signed by the taxpayer or an individual authorized to execute the Power of Attorney on behalf of the taxpayer. After the taxpayer executes a Power of Attorney, the Department of Revenue will communicate primarily with the taxpayer's representative. The Indiana Department of Revenue accepts faxed or electronic copies of original Power of Attorney Forms. If a copy is provided, the person forwarding the copy certifies, under penalties for perjury, that the copy is a true, accurate and complete copy of the original document. The Department will not accept a Power of Attorney form that has been plainly altered unless the Power of Attorney form has the initials of the taxpayer (or an individual authorized to execute the Power of Attorney on behalf of the taxpayer) beside the alteration(s). This Power of Attorney is effective for five (5) years from the date the form is signed. After the expiration of five (5) years, a new Power of Attorney form must be completed if the taxpayer wishes to permit the Department to communicate with the taxpayer's representative. This Power of Attorney can only be revoked prior to expiration by written and signed notice. A subsequent Power of Attorney alone will NOT revoke a prior Power of Attorney. To submit the form you may either: · · · fax to (317) 615-2605 email to poa1forms@dor.in.gov or mail to Indiana Department of Revenue P.O. Box 7230 Indianapolis, IN 46207-7230 American LegalNet, Inc. www.FormsWorkFlow.com
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