Form Le-10 - Power Of Attorney For Representing Employer/form Ui-1m - Unemployment Insurance Special Mailing Form

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LE-10 (Rev. 01/01)
Stock #6237
IL 427-0391
STATE OF ILLINOIS
DEPARTMENT OF EMPLOYMENT SECURITY
U.I. REVENUE
401 SOUTH STATE STREET
CHICAGO, ILLINOIS 60605-1229
Account No. ____________________
POWER OF ATTORNEY FOR REPRESENTING EMPLOYER
BEFORE THE DIRECTOR OF EMPLOYMENT SECURITY
UNDER THE ILLINOIS UNEMPLOYMENT INSURANCE ACT
KNOW ALL MEN TO THESE PRESENTS, That the employer, ___________________________________________________________
Name
_________________________________________________________________________________________________________________
State whether individual, partnership or corporation, etc.
located at _____________________________________________________________________________________________________
Address
has made, constituted and appointed, and by these presents does hereby make, constitute and appoint Representative,
____________________________________________________________________________________________________________________
Name and Address
as attorney(s)-in-fact for the employer, to represent the employer before the Director of Employment Security of the State of Illinois,
in any and all matters, proceedings and hearings pertaining to the employer's liability for the payment of contributions, interest and
penalties under The Illinois Unemployment Insurance Act.
Giving and granting unto the employer's said representative, full power and authority to do and perform all and every act and thing
whatsoever requisite, necessary and proper to be done, in and about the premises as fully to all intents and purposes as the employer
might or could do, hereby ratifying and confirming all that the employer's said attorney shall lawfully do or cause to be done by
virtue hereof. This Power of Attorney can be used to change the mailing addresses of only the documents specified on the reverse
side of this form. Unless the reverse side of this form is completed, no documents will be sent to the address designated on the
Power of Attorney. However, all documents other than those specified by the Department on the reverse side will be mailed to the
employer's last known place of business.
Dated at ___________________________________ , this ________ day of ______________________ , ____________.
________________________________________________________
Name of Employer
By ____________________________________________________
Signature
Title ___________________________________________________

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