Form R-7006 - Power Of Attorney And Declaration Of Representative
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R-7006 (11/08)
Power of Attorney and Declaration
of Representative
PLEASE TYPE OR PRINT.
State of
Parish/County of
Your Name or Name of Entity
Social Security/Louisiana or Federal ID Number
Spouse’s name, if joint (or corporate officer, partner
Spouse’s Social Security Number (if a joint return)
or fiduciary, if a business)
Mark one:
Original – your first power of attorney authorizing this act
Street address
Amend – changes an existing power of attorney for
(Name)
City/State/ZIP
Cancel/Revoke – cancels a previously filed power of attorney for
Expiration Date ______________________________
(Month/Day/Year)
(Name)
I/we appoint the following as my/our true and lawful agent and attorney-in-fact to represent me/us before the Louisiana Department of Revenue. The
agent and attorney-in-fact is authorized to provide and receive confidential and non-confidential information concerning my/our state taxes, and to
perform any and all acts that I/we can perform with respect to my/our tax matters, unless noted below.
Name #1
Name #2
Name #3
Name of firm
Name of firm
Name of firm
Street address
Street address
Street address
City/State/ZIP
City/State/ZIP
City/State/ZIP
Telephone number
Telephone number
Telephone number
Fax number
Fax number
Fax number
E-mail address
E-mail address
E-mail address
Unless noted, the agent and attorney-in-fact is authorized to perform any and all acts that you can perform with respect to your tax
matters, including the authority to sign tax returns. If you want to limit the agent and attorney-in-fact’s authority to specific tax types,
periods, and/or duties, you must indicate the types of authority below.
To grant limited authority: Mark only the boxes that apply. By marking the boxes, the agent and attorney-in-fact will be authorized to
perform acts on your behalf with respect to the indicated tax matters:
Tax type
Year(s) or period(s)
Tax type
Year(s) or period(s)
Individual income tax
Sales and use tax
Corporate income/franchise tax
Withholding tax
Special Fuels tax
Gasoline tax
Tobacco tax
Other (Please specify.)
Mark this box, if the agent and attorney-in-fact is authorized to sign the return(s) for the above tax matters.
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