Form Ador 01-5414 - Supplemental Power Of Attorney (Page 2 of 2) in pdf

Form Ador 01-5414 - Supplemental Power Of Attorney Page 2

Page 2

5. Acts Authorized

The representative(s) is/are authorized to receive and inspect conﬁ dential tax information and to perform any and all acts that the taxpayer can perform with respect

to the tax matters in question, for example, the authority to sign any agreements, consents, or other documents.

List any speciﬁ c restrictions to the acts otherwise authorized in this power of attorney:

6. Notice and Communications

Send copies of notices and other written communications addressed to the taxpayer(s) in proceedings involving the above tax matter to:

1. The representative ﬁ rst named above, or ..................................................................

2. Names of not more than two of the above named representative .............................

7. Retention of Prior Power(s) of Attorney

The ﬁ ling of this supplemental power of attorney is in addition to a valid executed power of attorney with the Department of Revenue and does not revoke any

earlier valid power(s) of attorney on ﬁ le with the Department of Revenue for the same tax matters.

Please attach a copy of any Department of Revenue power of attorney.

8. Signature for Taxpayer(s)

As appointed representative for the taxpayer(s), I hereby certify that the Director of Ofﬁ ce of Administrative Hearings, State of Arizona, is authorized to release any

and all information in Ofﬁ ce ﬁ les concerning the named taxpayer and relieve said Director, or Ofﬁ ce representative, of any liability whatsoever for releasing such

taxpayer information to the person(s) named in this supplement power of attorney. I certify that I have the authority to execute this supplemental power of attorney

on behalf of the taxpayer(s).

If this power of attorney is not signed, it will be returned.

(Representative Signature)

(Title, if applicable)

Date

Print Name

(Representative Signature)

(Title, if applicable)

Date

Print Name

Mail This To:

Ofﬁ ce of Administrative Hearings, 1400 W Washington, Suite 101, Phoenix AZ 85007.