Power Of Attorney - City Of Englewood

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City of Englewood
Income Tax Division
Power of Attorney
KNOW ALL MEN BY THESE PRESENT:
That I, _________________________ of _____________________________________________
Name of Grantor
Address of Grantor
County of ______________,State of ____________________, have made, constituted and appointed,
County
State
and by this document, do hereby appoint _________________________________________________
Name of Grantee
of ____________________________ County of __________________, State of ________________,
Address of Grantee
County
State
(_____)_______________,my true and lawful attorney in fact, for me and in my name and stead. I
Phone Number
hereby grant unto my said attorney full power and authority to do and perform any and every act and
thing that I might or could do, if personally present. I hereby ratify and confirm all that my said attorney
shall lawfully do or cause to be done by virtue of this POWER OF ATTORNEY.
This POWER OF ATTORNEY is limited for use at the City of Englewood, Income Tax Department for
the tax year(s) ____________ and/or concerning the matter of _______________________________.
Tax Year(s)
Explain Matter for Grantee to Discuss
I understand that the grantee may be permitted to view my tax record, including filings and income
received, and I further understand that the grantee may sign agreements and/or admit liability on my
behalf. Only the person named in the POWER OF ATTORNEY, after proper identification, shall have
the authority given by this document.
IN WITNESS WHEREOF, I have hereto set my hand this ______ day of _____________, _____.
Day
Month
Year
____________________________________
Name of Grantor
Be it remembered that the above-named person personally appeared before me, a (notary/attorney) in
and for said County, and acknowledged that (he/she) did sign the foregoing instrument and that the
same is (his /her) voluntary act and deed. In witness whereof, I have subscribed my name and official
seal, this _____ day of ________________, _____.
Day
Month
Year
____________________________________
Signature of Notary Public

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