Power Of Attorney - (Poa) Forms And Templates
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1
2Power of Attorney
1.
CLAIMANT INFORMATION
*Last name or company legal name
*Your first name/middle initial
*SSN or EIN
*Spouse’s last name
*Spouse’s first name/middle initial
*Spouse’s SSN
*Address
Daytime telephone number
*City, State, Zip
E-mail address
2.
REPRESENTATIVE(S) - For multiple representatives, attach additional sheets.
*Name
PTIN, EIN or SSN
*Firm or company’s legal name
Telephone number
*Address
Fax number
*City, State, Zip
E-mail address
3.
MATTERS APPROVED FOR REPRESENTATION*
The above representative is hereby appointed as attorney-in-fact to represent the claimant(s) for the following unclaimed property matter(s) involving the
Idaho State Treasurer. You must identify the matter type(s).
All Unclaimed Property Matters
Tangible Property Matters
Intangible Property Matters
4.
ACTIONS AUTHORIZED
The representative(s) are authorized to receive and inspect confidential unclaimed property information and records, as well as perform any and all
actions that the claimant(s) named above can perform with respect to the specified unclaimed property matters listed. The authority doesn’t include the
power to receive unclaimed property.
Added or deleted actions - List any specific additions or deletions to the actions otherwise authorized in this Power of Attorney:
_________________________________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
5.
REVOCATION/EXPIRATION
The filing of this Power of Attorney (POA) automatically revokes all prior POAs on file with the Idaho State Treasurer for the same matters authorized in
this document.
Check here if you don’t want to revoke prior POA(s):
Expiration date (optional): _____________________________
6.
SIGNATURE OF CLAIMANT(S)
All parties identified in Section 1 MUST sign.
If signed by a corporate officer, partner, LLC member, guardian, executor, receiver, administrator, or trustee on behalf of the claimant; I certify that I have
the authority to execute this form.
*Name
Title (If applicable)
Date
Title (If applicable)
Date
*Name
*
Required Information.
This form is valid only if all information is complete. An incomplete form will be returned to you.
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