Form Mo 860-1723, Dor-2827 Draft - Sample Power Of Attorney - Missouri Department Of Revenue 2009

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MISSOURI DEPARTMENT OF REVENUE
POWER OF ATTORNEY
PLEASE TYPE OR PRINT
(Submission of a DOR-2827, Power of Attorney, by a taxpayer is not in itself sufficient as official notice to the
Department of Revenue of an address change.)
TAXPAYER’S NAME OR BUSINESS NAME
SOCIAL SECURITY NUMBER/FEDERAL I.D. NUMBER
__ __ __ __ __ __ __ __ __
SPOUSE’S NAME OR IF A D/B/A, STATE THE BUSINESS NAME
SPOUSE’S SSN/FEDERAL I.D. NUMBER
__ __ __ __ __ __ __ __ __
STREET ADDRESS
MISSOURI TAX I.D. NUMBER
__ __ __ __ __ __ __ __
CITY OR TOWN, STATE, ZIP CODE
TELEPHONE NUMBER
MISSOURI CHARTER NUMBER
(__ __ __) __ __ __ - __ __ __ __
__ __ __ __ __ __ __ __ __ __
TAXPAYER(S) HEREBY APPOINTS
NAME OF APPOINTED REPRESENTATIVE
ADDRESS
TELEPHONE NUMBER
(__ __ __) __ __ __ - __ __ __ __
NAME OF APPOINTED REPRESENTATIVE
ADDRESS
TELEPHONE NUMBER
(__ __ __) __ __ __ - __ __ __ __
NAME OF APPOINTED REPRESENTATIVE
ADDRESS
TELEPHONE NUMBER
(__ __ __) __ __ __ - __ __ __ __
NAME OF APPOINTED REPRESENTATIVE
ADDRESS
TELEPHONE NUMBER
(__ __ __) __ __ __ - __ __ __ __
as attorney(s)-in-fact to represent taxpayer(s) before the Department of Revenue, State of Missouri, but not otherwise, with
respect to the following tax matter(s) (the tax type, form(s), and year(s) to which this form applies must be listed below):
TYPE OF TAX (INDIVIDUAL, SALES, CORPORATE
MISSOURI TAX FORM NUMBER
YEAR(S) OR PERIOD(S)
INCOME/FRANCHISE, WITHHOLDING, ETC.)
(MO-1040, MO-1120, ETC.)
(DATE OF DEATH IF ESTATE TAX)
Each attorney-in-fact is authorized, subject to revocation, to receive confidential information and perform any and all acts that
the taxpayer(s) can perform with respect to the above specified tax matters, but not the power to endorse or receive checks in
payment of any refunds. Failure of representative to receive notice does not relieve the taxpayer of responsibility to respond to
notices.
Copies of notices and other written communications addressed to taxpayer(s) in proceedings involving the above tax matters
should be sent to:
1. the representative first named above; or
2. the following named representative(s) (no more than two):
By execution of this power of attorney, all earlier powers of attorney on file with the Department of Revenue, State of Missouri, for
the same tax matter(s) and years or periods covered by this power of attorney are revoked, except the following (specify to whom
power of attorney was granted, date and address, or refer to attached copies of earlier powers of attorney and authorizations.):
Note: All appointed representatives must sign on reverse side of this form.
MO 860-1723 (11-2009)
DOR-2827 (11-2009)

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