Form Uitl-18 - Power Of Attorney
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1Colorado 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
Acceptance of New Power of Attorney
_____________________________
Effective Date of Acceptance
The acceptance of the new power of attorney is for:
All unemployment insurance (UI) information
UI tax-related information only
UI benefit-claim-related information only
Your acceptance of a new power of attorney supersedes any existing power of attorney previously approved by UI Operations.
Name and Complete Address 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.
Complete Mailing Address
Telephone Number
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. Complete only if the address is different from the address you provided above.
Complete Mailing Address (for UI benefit-claim-related correspondence)
Telephone Number
Power-of-Attorney Signature
Power of Attorney Representative Name (Print Name)
Title
Power of Attorney Representative Signature (Required)
Date
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 Official (Print Name)
Title
Signature of Employer Official (Required)
Date
To be completed by notary public to authenticate employer signature
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 08/2008)
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Parent category: Legal