Form Uitl-18 - Power Of Attorney
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1
2Colorado Department of Labor and Employment
Unemployment Insurance Operations, P.O. Box 8789, Denver, CO 80201-8789
303-318-9100 (Denver-metro area) or 1-800-480-8299 (outside Denver-metro area)
POWER OF ATTORNEY
Please print or type the information. Instructions for completing this form are provided on the reverse.
Employer Information
Employer Name
Trade Name
Employer Account Number (Required)
Street Address
City
State
ZIP Code
Purpose of Application (Check all that apply)
_____________________________
Acceptance of power of attorney
Effective Date
Does this power of attorney supersede a previous power of attorney?
Yes
No
If Yes, complete Discontinuation of power of attorney below.
_____________________________
Discontinuation of power of attorney
Effective Date
Name of the entity or individual with power of attorney to be discontinued _________________________________________________
For all unemployment insurance (UI) information
For UI tax-related information
For UI benefit-claim-related information
For all distribution points of this account number
For specified distribution points of this account number
Name of Power of Attorney
Mailing-Address Information
Provide your preferred mailing address for UI correspondence. All UI correspondence will be mailed to the address you provide below unless you
elect to have UI-benefit-claim-related information sent to a different address. UI tax-related forms include, but are not limited to, Forms UITR-1,
Unemployment Insurance Tax Report; UITR-1a, Unemployment Insurance Report of Worker Wages; UITR-2, Unemployment Insurance Tax
Statement; UITR-7, Notice of Employer’s Tax Rate; and UITD-1, Notice of Delinquent Tax Report.
Complete Mailing Address
Telephone Number
Complete only if different from above. If you prefer to have UI benefit-claim-related information sent to a different address, complete this
section. If not, all UI correspondence will be mailed to the address you provided above. UI benefit-related forms include, but are not limited to,
Forms UIB-290, Request for Job-Separation Information; UIF-290, Notice of Wages Reported/Potential Charges; and UIB-6, Notice of Decision.
Complete Mailing Address
Telephone Number
Employer Approval
I hereby grant permission to the above-named entity or individual to act on my behalf for the purpose stated on this document.
Employer Name (Printed)
Title
Employer Signature (Required)
Date
Power of Attorney Representative Signature (Required)
Title
Date
City of
__________________________________________
)
County of
__________________________________________
) SS.
State of
__________________________________________
)
Subscribed and sworn to before me this ________ day of _________________________, ____________.
My Commission Expires
Notary Public
Office Use Only
Date
Initials
Power of attorney approved by UI Operations
UITL-18 (R 08/2006)
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