Form Uct-62 - Power Of Attorney - Florida Department Of Labor And Employment Security

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Florida Department of Labor and Employment Security
Division of Unemployment Compensation
Bureau of Tax - Employer Records
107 E. Madison Street
Tallahassee, FL 32399-0239
P O W E R O F A T T O R N E Y
THE POWER OF ATTORNEY SHOULD BE AN ORIGINAL FORM AND SHOULD CONTAIN INFORMATION WHICH IS COMPLETE AND
VERIFIABLE WITH THE DIVISION'S RECORDS. THE DIVISION RECOMMENDS THE POWER OF ATTORNEY BE NOTARIZED OR WITNESSED
FOR THE PROTECTION OF EMPLOYER RECORDS.
PLEASE BE ADVISED:
EMPLOYER NAME (LEGAL ENTITY)
UC ACCOUNT NO. (REQUIRED)
TRADE NAME (IF APPLICABLE)
FEDERAL I.D. NO. (REQUIRED)
ADDRESS (NUMBER AND STREET)
CITY, STATE AND ZIP CODE
PHONE NUMBER
DOES HEREBY APPOINT AS ATTORNEY-IN-FACT:
NAME
FEDERAL I.D. NO. (REQUIRED)
ADDRESS (NUMBER AND STREET)
PHONE NUMBER
CITY, STATE AND ZIP CODE
THE ATTORNEY-IN-FACT IS AUTHORIZED, SUBJECT TO REVOCATION, TO RECEIVE CONFIDENTIAL INFORMATION AND TO PERFORM ANY
AND ALL ACTS THE EMPLOYER CAN PERFORM RELATING TO MATTERS PERTAINING TO THE FLORIDA UNEMPLOYMENT COMPENSATION
PROGRAM.
ANY LIMITATIONS MUST BE SPECIFICALLY STATED AND ATTACHED TO THE POWER OF ATTORNEY.
REPORTS AND
CORRESPONDENCE WILL BE SENT TO THE EMPLOYER'S MAILING ADDRESS AS IT APPEARS IN THE DIVISION'S RECORDS AT TIME OF MAILING.
ANY REQUEST FOR SPECIFIC COPIES OF THE EMPLOYER'S RECORDS OR DOCUMENTS ON FILE WITH THIS DIVISION MUST BE IN WRITING
AND INCLUDE THE EMPLOYER'S NAME AND FLORIDA UNEMPLOYMENT COMPENSATION ACCOUNT NUMBER.
THIS POWER OF ATTORNEY REVOKES ALL EARLIER POWERS OF ATTORNEY ON FILE AND SHALL REMAIN IN EFFECT UNTIL RECEIPT OF
A WRITTEN NOTICE OF REVOCATION OR RECEIPT OF A SUBSEQUENT POWER OF ATTORNEY BY THE BUREAU OF TAX AT THE ABOVE
ADDRESS. FORGING A POWER OF ATTORNEY IS A VIOLATION OF FLORIDA STATUTE 831.02.
(NOTARY)
(AUTHORIZED SIGNATURE)
(PRINT OR TYPE NAME)
WITNESS
(TITLE)
WITNESS
(DATE)
LES FORM UCT-62 (REV. 8/13/98)
Internet Address:

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