Form Oes-190t Power Of Attorney - Tax - Oklahoma Employment Security Commission
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1OES-190T (Rev.4-07)
OKLAHOMA EMPLOYMENT SECURITY COMMISSION
POWER OF ATTORNEY – TAX
I, ___________________________________, am the owner or officer with authority to contract for
__________________________________________________________________________________________,
Oklahoma Account #_____________________________, Federal ID #_________________________________.
I hereby appoint:
Matthew Sanford - Payroll Center
Name:
____________________________________
2300 Lake Park Drive Ste 270
Address:
____________________________________
Smyrna, GA 30080
City, State, and Zip:
____________________________________
877-328-6505
Telephone No.:
____________________________________
678-829-7291
Fax No.:
____________________________________
As attorney-in-fact to represent the above-named taxpayer before the Oklahoma Employment Security
Commission with respect to all unemployment insurance tax matters and issues arising pursuant to Article III of
the Employment Security Act of 1980. This Power of Attorney shall be effective immediately and shall remain in
effect until the Oklahoma Employment Security Commission receives notice of its revocation. A notice of a
revocation of a Power of Attorney or a notice of change of address must be in a separate writing and mailed to the
Oklahoma Employment Security Commission at P.O. Box 52003, Oklahoma City, OK 73152-2003. The attorney-
in-fact is authorized to receive all confidential information pertaining to the taxpayer’s unemployment insurance
tax account. This Power of Attorney removes all earlier Powers of Attorney previously granted by the taxpayer for
unemployment insurance tax purposes.
____________________________________
________________________________________
Date
Signature
________________________________________
Printed Name
________________________________________
Title
ACKNOWLEDGMENT
State of __________________)
) SS.
County of ________________)
Before me, the undersigned, a notary public in and for this county and state, personally appeared
___________________________ and acknowledged to me that he/she executed the above instrument in his/her
official capacity as the free and voluntary act and deed of himself/herself and the taxpayer.
In
witness
of
this
fact,
I
signed
this
document
and
affixed
my
official
seal
on
________________________________, ________.
Official Seal with Commission Number
And Expiration Date:
_____________________________________________
Notary Public
RESET FORM
0190
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