Power Of Attorney printable pdf download

Power Of Attorney

POWER OF ATTORNEY

KNOW ALL PERSONS BY THESE PRESENTS:

THAT, ________________________________, GA DOL Account No. ___________________,

having its principal office at ______________________________________________, hereby

appoints ____________________________ as its true and lawful agent with full authority to

represent the said __________________________ before the Georgia Department of Labor,

until further notice, in connection with all matters affecting State Unemployment Insurance

Taxes including, without limitation, all claims, tax contributions and experience ratings.

This Power of Attorney supersedes and revokes any prior power of attorney authorization from

the named employer relating to the subject matter hereof. The undersigned warrants that he or

she is authorized to execute this Power of Attorney.

IN WITNESS WHEREOF, the undersigned has duly executed and delivered this Power of

Attorney on behalf of the named employer this _____ day of __________________ 20____.

___________________________________

Employer’s Name

By: ___________________________________

Signature

___________________________________

Print or Type Name

___________________________________

Title

It is respectfully requested that all forms pertaining to unemployment taxes be mailed to the new

ADDRESS OF RECORD as indicated below.

Power Of Attorney