Power Of Attorney

EFO00104 02 - 20 - 2018 Idaho State Tax Commission Power of Attorney 1. TAXPAYER /GRANTOR INFORMATION 2. REPRESENTATIVE(S) - If a r epresentative name is provided, authorization is limited to that individual. If a company name is p rovided without specifying an individual, authorization is granted to employees of the company. I , or my company , a m authorized to represent the taxpayer(s) identified above: Representative or authorized individual Signature Title (If applicable) Date Cease date of this POA (o ptional): Check her e if you want the representative to receive copies of notices and communications : 3. TAX MATTERS APPROVED FOR REPRESENTATION The above representative is hereby appointed as attorney - in - fact to represent the taxpayer /grantor (s) before the Idaho State Tax Commission for the following tax or fee matter(s). You must identify the tax or fee type , permit number (if applicable) , and specific periods /years. The representative(s) are generally author ized to receive and inspect confidential tax or fee information and records and perform any and all actions that the taxpayer /grantor (s) named above can perform with respect to the specified tax or fee matters listed. The authority doesn t include the pow er to receive refund checks or appoint additional representatives . * Tax or Fee Types State Tax /Fee Permit Numbe r * Tax Periods /Years OR mm/dd/yyyy - mm/dd/yyyy or yyyy) Individual income t ax or Business income t ax All Sales & use t ax All Income tax w ithholding All Other t ax /fee (specify ) All All All Check here to revoke all prior POA( s ) Check here to k eep all prior POA ( s ) Check here to revoke t he following POA(s) 4 . SIGNATURE OF TAXPAYER /GRANTOR (S) All parties identified in Section 1 MUST sign . If signed by a corpor ate officer, partner, guardian, tax matters partner, executor, receiver, administrator, or tr ustee on behalf of the taxpayer /grantor: I certify that I have the authority to execute this form. * Print n ame * Signature Title (i f appli cable) Date * Print n ame * Signature Title (i f applicable) Date * Require d Information . This form is valid only if all information is complete. An i ncomplete form will be returned to you . * * Taxpayer/g first name/middle initial * Taxpayer/g SSN or EIN * * Sp * * Current a ddress Daytime telephone number * City, s tate, Z IP Code E mail address n ame PTIN, EIN , or SSN Name Telephone number * Current a ddress Fax number * City, s tate, Z IP Code E mail address American LegalNet, Inc. www.FormsWorkFlow.com EFO00104p 2 02 - 20 - 2018 IDAHO STATE TAX COMMISSION P OWER OF ATTORNEY PURPOSE OF FORM A Power of Attorney (POA) is a legal document authorizi ng someo ne to represent you. You, the taxpayer/grantor, must complete, sign, and return this form if you want to grant power of attorney to an accountant, tax return preparer, attorney, family member , or anyone else to act on your behalf with the Idaho Sta te Tax Commission. SPECIFIC INSTRUCTIONS SECTION 1 TAXPAYER INFORMATION Individuals Enter your name, Social Security number (SSN), Individual Taxpayer Identification Number (ITIN), and/or federal E mployer Identification N umber (EIN), if applicable; your st reet address or post office box; telephone number; and email address. If you file a tax return that includes a sole proprietorship business (Federal Schedule C) and you are authorizing the listed representative(s) to represent you for your individual a nd business tax matters, enter both your SSN (or ITIN) and you r business EIN as your taxpayer identification numbers. C orporations , P artnerships , or A ssociations Enter the entity name, EIN, business address, telephone number, and email address. SECT ION 2 REPRESENTATIVE(S) Enter the name, mailing address, Paid Preparer Tax Identification Number ( PTIN ) , EIN, or SSN, telephone number, fax number , and email a ddress of your representative. repres entative, t he company name is sufficient. each person authorized. If you want to appoint only a specific person in the company as your repres name. Cease Date This form is effectiv e on the date signed and will remain in effect until the cease date or until revoked. If you want the form to cease , provide a specific date on the cease date line provided , such as December 31, 2016. If date, the form is in effect unt il revoked. If you want your represe ntative to receive copies of notices and communications that we send to you, check the appropriate SECTION 3 TAX MATTERS APPROVED FOR REPRESENTATION You can u se this form for any matter affecting a tax or fee that the Tax Commission administers , includin g audit and collection matters. Tax or Fee Types Check the bo You can check the box for all tax types. State Tax/Fee Permit Number Enter the state tax/fee permit number if applicable. If you provide a permit number , authorization is limit ed to only that ac count. If the form is valid for all accounts the taxpayer has in that tax type. Tax Periods/Years You can check the box for all tax y ears (includes past, current , and future), list consecutive years or inclusive periods such as 2010 - 2015 , or list specific years such as calendar year 2015 . . For fiscal years, enter the ending such as now, present, or today . Forms with a general reference or no reference to an end date will be returned. American LegalNet, Inc. www.FormsWorkFlow.com EFO00104p3 02 - 20 - 2018 Replacing a POA You can appoint or change representative(s) at any t ime by submitting a POA. If you previously filed a POA with the Tax Commission and are submitting another POA, you must check the appropriate box on the POA form to let us know your intent for the previously filed POA(s). If no boxes are checked, the f orm is considered incomplete and will be returned to you. See the box definitions below: Check here to revoke all prior POA(s) Checking this box revokes all prior POA(s) on file with the Tax Commission for the same tax matters and years or periods covered by this form. Check here to keep all prior POA(s) Checking this box keeps all prior POA(s) on file with the Tax Commission and adds this POA for the same tax matters and years or periods covered by this form. Check here to revoke the following POA(s) If you check this box, list on the line which specific POA(s) you want to revoke. Revoking a POA You may revoke a POA or the representative may withdraw at any time by submitting a copy of the previously executed the form with your signature and date. You can also submit a written statement specifying your intention to revoke a POA or withdraw as the representative. You must sign and date the statement and include the name, address, and SSN/EIN of the taxpayer/g rantor and the name and address of the representatives whose authority is being revoked or withdrawn. SECTION 4 SIGNATURE OF TAXPAYER/GRANTOR(S) I ndividuals You must sign and date the form. If you filed a joint return, your spouse must also sign and da te the form. C orporations An officer with the legal authority to bind the corporation must sign and enter his or her exact title and date the form. P artnerships /LLCs If one partner or member is authorized to act in the name of the partnership or LLC, only that partner or member is required to sign and enter his or her title and date the form. E states If there is more than one executor, only one co - executor having the authority to bind the estate is required to sign. FILING THIS FORM rking with a specific section and/or employee of the Tax Commission, mail or fax the completed POA to that section and/or employee. Otherwise, mail or fax the completed form to: Idaho State Tax Commission Accounts Registration Department P.O. Box 36 Bois e, ID 83722 - 0410 Fax: (208) 334 - 5364 American LegalNet, Inc. www.FormsWorkFlow.com