Power Of Attorney Form - Pinellas County Tax Collector

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TAX COLLECTOR, PINELLAS COUNTY
P.O. Box 6440
Clearwater, FL 33758-6440
POWER OF ATTORNEY FOR RELEASE OF TOURIST TAX INFORMATION
NOTARIZATION REQUIRED
Tourist Development Tax Account No.
Date:
I hereby name and appoint:
Appointee:
Title:
Phone:
Email:
Company:
Address:
City:
State:
Zip Code:
to be my lawful Attorney in Fact to act for me with respect to my Pinellas County Tourist Development Tax
account pursuant to Sections 118-31 to 118-70 Pinellas County Code. My Attorney in Fact is authorized to
receive and inspect confidential tax information and to perform any and all acts with respect to the above
referenced Tourist Development Tax account and is further authorized to enter into binding resolutions
regarding any and all disputes as to the above account(s).
____________________________________
Signature of Owner
Owner’s name-type or print
Sworn to (or affirmed) and subscribed before me this _____ day of ____________________, _________.
By: _______________________________
___________________________________
(
Name of Person making statement)
(Print, type or stamp commissioned name of Notary)
SEAL
___________________________________________________
(Signature of Notary)
Personally Known
or Produced Identification
. Type of Identification__________________
Pctd8
Print
Revised 12/27/2016

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