Power Of Attorney Form Page 2
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2I grant full authority to the appointee. The appointee is authorized to perform on my behalf any and all
acts I can perform with respect to any matters related to the Minnesota Angel Tax Credit Program and to
have access to and be entitled to discuss with the Program’s staff any and all data contained in my
application(s) for participation in the Program as well as any other data in the possession of the State of
Minnesota or any of its agencies that may be relevant to determining my eligibility to participate or
continue in the Program.
I grant limited authority to the appointee. The appointee is authorized to perform only the acts I
describe below with respect to my matters related to the Minnesota Angel Tax Credit Program:
Section III. APPLICANT’S NOTARIZED SIGNATURE
NOTE: The power of attorney is not valid until it is signed and dated by the applicant in the presence of a
notary public.
___________________________________________________________________________________
Applicant’s signature
Date
________________________________________________
Applicant’s name (printed)
________________________________________________
Applicant’s Business or Fund Name (if applicable)
________________________________________________
Applicant’s Business or Fund Title (if applicable)
Notary Public Acknowledgment
STATE OF
COUNTY OF
The foregoing Power of Attorney Form was acknowledged before me on:
_______________ By _______________________________ of _______________________________
Business or Fund Name (if applicable)
Date
Applicant’s Name
SEAL
_________________________________________________________
Notary Public
Mail form to:
Minnesota Department of Employment and Economic Development
Angel Tax Credit Program, Attn: Jeff Nelson
First National Bank Building
332 Minnesota Street, Suite E-200
St. Paul, MN 55101-1351
MN DEED Angel Tax Credit Program
Power of Attorney Form 2016
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