INDIVIDUAL ACKNOWLEDGEMENT
CORPORATE ACKNOWLEDGEMENT
TO BE FILED ONLY IN CONNECTION WITH MATTERS
TO BE FILED ONLY IN CONNECTION WITH MATTERS
INVOLVING AN INDIVIDUAL OR UNINCORPORATED TAXPAYER
INVOLVING AN INCORPORATED TAXPAYER
STATE OF
STATE OF
SS:
SS:
COUNTY OF
COUNTY OF
On this _______ day of ________________, _______,
On this _______ day of ________________, _______,
before me personally came ___________________________
before me personally came ___________________________
________________________________________ known to me,
________________________________________ known to me
who being duly sworn, deposes and says that he/she resides in
to be the individual described herein, and acknowledged that
__________________________________________________;
he/she executed the same.
that he/she is the _____________________________________
of _____________________________________________, the
corporation described in and which executed this Power of
SIGNATURE OF NOTARY ADMINISTERING OATH
Attorney; and that he/she signed his/her name thereto by order
of the board of directors of the corporation.
EXPIRATION DATE OF APPOINTMENT
SIGNATURE OF NOTARY ADMINISTERING OATH
If you have an
EXPIRATION DATE OF APPOINTMENT
official stamp or
seal, affix it here.
If you have an
official stamp or
seal, affix it here.
N O T I C E O F A P P E A R A N C E
I agree to represent the above named taxpayer in accordance with the terms of the Power of Attorney set forth above and
I certify that I am a(n):
Attorney-at-Law
Public Accountant
Other: _______________________________
Certified Public Accountant
Enrolled Agent
SIGNATURE
DATE
Attorney-at-Law
Public Accountant
Other: _______________________________
Certified Public Accountant
Enrolled Agent
SIGNATURE
DATE
Attorney-at-Law
Public Accountant
Other: _______________________________
Certified Public Accountant
Enrolled Agent
SIGNATURE
DATE
TAT POA