Form 68-0092 - Power Of Attorney - Iowa Workforce Development

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Iowa Workforce Development - Tax Bureau
ACCOUNT NUMBER/LOCATION OR SSN
DOCUMENT ID NUMBER DOCUMENT CONTROL DATE
68-0092
1000 East Grand Avenue
DESCRIPTION
Des Moines, Iowa 50319-0209
FOR
DESCRIPTION CONTINUED
ADMINISTRATIVE
OFFICE USE ONLY
POWER OF ATTORNEY
68-0092 (10-06) -- 3091075
This is to advise that - - -
Does Hereby Appoint:
EMPLOYER NAME
NAME
ADDRESS (INCLUDE CITY, STATE AND ZIP CODE)
ADDRESS (INCLUDE CITY, STATE AND ZIP CODE)
IOWA EMPLOYER ACCOUNT NUMBER
Its true and lawful agent with full power and authority to represent the said employer before
Iowa Workforce Development, until further notice, in:
ALL matters AFFECTING Unemployment Insurance Tax, including claims, contributions and
experience rating.
THIS AUTHORIZATION CANCELS AND SUPERSEDES ALL PRIOR AUTHORIZATIONS.
Submit the orginal copy of this agreement to:
Iowa Workforce Development
Unemployment Insurance - Tax Bureau
1000 East Grand Avenue
Des Moines, Iowa 50319-0209
Employer: .........................................................................................
By: ....................................................................................................
Title: .................................................................................................
Date: ................................................................................................

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