Form Dr-835 - Power Of Attorney And Declaration Of Represntative - 2004
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2DR-835
POWER OF ATTORNEY
R. 06/04
and Declaration of Representative
PART 1 - POWER OF ATTORNEY
1. TAXPAYER INFORMATION
(Taxpayer(s) must sign and date this form on Page 2, Part I, Section 8)
TAXPAYER NAME(S) AND ADDRESS (Please Type or Print)
TAXPAYER IDENTIFICATION NO(S).
FLORIDA TAX REGISTRATION NUMBER
(SSN, FEIN, etc.)
DAYTIME TELEPHONE NUMBER
(
)
Hereby appoint(s) the following representative(s) as attorney(s)-in-fact:
2. REPRESENTATIVE(S)
(Each representative must be listed individually, and must sign and date this form on Page 2, Part II)
NAME AND ADDRESS (Please Type or Print)
TELEPHONE NUMBER
(
)
FAX NUMBER
(
)
NAME AND ADDRESS (Please Type or Print)
TELEPHONE NUMBER
(
)
FAX NUMBER
(
)
NAME AND ADDRESS (Please Type or Print)
TELEPHONE NUMBER
(
)
FAX NUMBER
(
)
To represent the taxpayer(s) before the Florida Department of Revenue in the following tax matters:
3. TAX MATTERS
TYPE OF TAX (Corporate, Sales, Intangible, etc.)
TAX FORM NUMBER (F-1120, DR-15, DR-601, etc.)
YEAR(S) / PERIOD(S) / MATTER(S)
4. ACTS AUTHORIZED
The representative(s) are authorized to receive and inspect confidential tax information and to perform any and all acts that I (we) can perform with
respect to the tax matters described in section 3, (for example, the authority to sign any agreements, consents, or other documents). The authority
specifically includes the power to execute waivers of restrictions on assessment or collection of deficiencies in tax, to execute consents extending the
statutory period for assessment or claims for refund of taxes, and to execute closing agreements under section 213.21, Florida Statutes. The authority
does not include the power to receive refund warrants or the power to sign certain returns.
LIST ANY SPECIFIC ADDITIONS OR DELETIONS TO THE ACTS OTHERWISE AUTHORIZED IN THIS POWER OF ATTORNEY
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
5. RECEIPT OF REFUND
If you want to authorize a representative named in section 2 to receive, BUT NOT TO ENDORSE OR CASH, refund warrants, initial here____________
and list the name of that representative below.
NAME OF REPRESENTATIVE TO RECEIVE REFUND WARRANTS: __________________________________________________________________________________
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