Form R-7005 - Power Of Attorney Page 2
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2The filing of this Power of Attorney with the Louisiana Department of Revenue revokes all earlier Power(s) of
Attorney on file for the same taxes and taxable year(s) or period(s) covered by this document.
If this Power of Attorney is not signed and dated by all parties, it will be returned.
By signing this Power of Attorney as a corporate officer, partner, guardian, tax matters partner, executor, receiver,
administrator, or trustee on behalf of the taxpayer, I certify that I have the authority to execute this form on behalf of the
taxpayer. If this matter concerns a joint return filed by a husband and wife, both must sign if joint representation is requested.
____________________________________________________________________________
__________________
Taxpayer signature
Date
____________________________________________________________________________
__________________
Spouse signature
Date
__________________________________________________
________________________
__________________
Signature of duly authorized representative, if the taxpayer
Title
Date
is a corporation, partnership, executor or administrator
Under penalties of perjury, I declare that:
• I am not currently under suspension or disbarment from practice before the Internal Revenue Service.
• I am one of the following:
a. Attorney—a member in good standing of the highest court of the jurisdiction shown below.
b. Certified Public Accountant—duly qualified to practice as a certified public accountant in the jurisdiction shown below.
c. Enrolled Agent—a person enrolled to practice before the Internal Revenue Service.
d. Officer—a bona fide officer of the taxpayer organization.
e. Employee—an employee of the taxpayer.
f. Family Member—a member of the taxpayer’s immediate family (state the relationship, i.e., spouse, parent, child,
brother, or sister)______________________________________________________________________________.
g. Other (state the relationship, i.e., bookkeeper or friend)________________________________________________.
Designation-Insert
Jurisdiction and Enrollment/
Signature
Date
Applicable Letter (a.-g.)
Bar Number, if applicable
Thus Sworn to and Subscribed Before Me, Notary, in the presence of the undersigned two witnesses, who
personally came and appeared, on this ________ day of ____________________________, 20____.
__________________________________
__________________________________________
Signature of witness
Notary
__________________________________
__________________________________________
Print witness name
Print name of Notary and Notary Number
__________________________________
Signature of witness
__________________________________
Print witness name
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Parent category: Financial