Power Of Attorney - City Of Columbus

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City of Columbus
Income Tax Division
Power of Attorney
KNOW ALL MEN BY THESE PRESENT:
hat I, _____________________________ of _________________________________ County
T
Name of Grantor
Address
of ____________________, State of _______________, have made, constituted and appointed,
State
County
and by this document, do hereby appoint ___________________________________________ of
Name of Grantee
_______________________________________, County of ________________________, State
County
Address
of ___________________, my true and lawful attorney in fact, for me and in my name and stead.
State
I hereby grant unto my said attorney full power and authority to do and perform any and every act
and thing that I might or could do, if personally present. I hereby ratify and confirm all that my said
attorney shall lawfully do or cause to be done by virtue of this POWER OF ATTORNEY.
This POWER OF ATTORNEY is limited for use at the City of Columbus Income Tax Division.
I understand that the grantee may be permitted to view my tax record, including filings and income
received, and I further understand that the grantee may sign agreements and or admit liability on
my behalf. Only the person named in the POWER OF ATTORNEY, after proper identification
shall have the authority given by this document.
IN WITNESS WHEREOF, I have hereto set my hand this _____ day of ________________,
Month
Day
______.
Year
Signature of Grantor
Be it remembered that the above named person personally appeared before me, a (notary / attorney)
in and for said County, and acknowledged that ( he / she ) did sign the foregoing instrument and
that the same is ( his / her ) voluntary act and deed. In witness whereof, I have subscribed my
name and official seal, this ______ day of __________________, ______.
Day
Month
Year
Signature of Notary Public

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