Form R-7015 - Power Of Attorney
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1State of Louisiana
R-7015 (8/01)
Department of Revenue
ADR#21
Field Audit Services Division
Power of Attorney
(Procuration)
By:
______________________________________________________ State of ___________________________
Taxpayer
To:
_______________________________________________ Parish/County of ___________________________
Agent/attorney in fact
Know All by These Presents:
_________________________________________________________
__________________________________
Taxpayer
Business master file number (Account number)
_________________________________________________________
__________________________________
Address
Phone and fax numbers
does hereby make, name, constitute and appoint ________________________________________________________
Agent/attorney in fact
_________________________________________________________
__________________________________
Mailing address
Phone and fax numbers
my true and lawful agent and attorney in fact for me and in my name, place and stead to receive and inspect confidential tax
information and to perform any and all acts that this taxpayer can perform with respect to the taxes and taxable year(s)/
period(s) set forth below. The authorizations granted above apply to Louisiana
__________________________________________________________________________________________ tax(es)
List tax types.
for the taxable year(s)/period(s) ______________________________________________________________________ .
The agent and attorney in fact shall be authorized to receive copies of notices and communications from the Louisiana
Department of Revenue. The taxpayer will receive the original notices and written communications. The 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.
By signing this document 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.
_____________________________________
____________
________________________________________
Signature of taxpayer or duly authorized representative
Date
Title (if applicable)
_____________________________________
Print name of taxpayer or duly authorized representative.
_____________________________________
____________
________________________________________
Signature of taxpayer or duly authorized representative
Date
Title (if applicable)
_____________________________________
Print name of taxpayer or duly authorized representative.
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