Fillable Form R-7006 - Power Of Attorney And Declaration Of Representative (Page 2 of 2) in pdf

The agent and attorney-in-fact does not have the power to: (Mark only the items below you do not wish to grant.)

 Execute agreement to suspend prescription of tax.

 File a protest to a proposed assessment.

 Execute offers in compromise or settlement of tax liability.

 Represent the taxpayer before the department in any proceeding, including protest hearings.

 Obtain a private letter ruling on behalf of the taxpayer.

 Perform other acts. (Explain.) _____________________________________________________________________

The agent and attorney-in-fact shall be authorized to receive copies of notices and communications from the Louisiana Department of Revenue

upon request. The taxpayer will continue to be mailed the original notices and written communications. The authority does not include the power

to receive and to sign refund checks or the power to substitute another representative unless specifically marked below:

 Receive checks in payment of any refund of Louisiana taxes, penalties, or interest.

 Endorse or collect checks in payment of refunds.

 Delegate authority or substitute another representative.

The filing of this Power of Attorney automatically revokes all earlier Power(s) of Attorney on file with the Louisiana Department of

Revenue for the same tax matters and years or periods covered by this document. If you do not want to revoke or cancel the author-

ity of an agent and attorney-in-fact, mark here . You must attach a copy of any Power of Attorney you want to remain in effect.

If this Power of Attorney is not signed and dated by all parties, it will be returned.

By signing this Power of Attorney 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.

_____________________________________________________________________________________

____________________

Taxpayer signature

Date

_____________________________________________________________________________________

____________________

Spouse signature

Date

_________________________________________________

__________________________________

____________________

Signature of duly authorized representative, if the taxpayer

Title

Date

is a corporation, partnership, executor or administrator

Under penalties of perjury, I declare that:

• I am not currently under suspension or disbarment from practice before the Internal Revenue Service or the Louisiana State Bar Association.

• I am one of the following:

a. Attorney—a member in good standing of the highest court of the jurisdiction shown below.

b. Certified Public Accountant—duly qualified to practice as a certified public accountant in the jurisdiction shown below.

c. Enrolled Agent—a person enrolled to practice before the Internal Revenue Service.

d. Officer—a bona fide officer of the taxpayer organization.

e. Employee—an employee of the taxpayer.

f. Family Member—a member of the taxpayer’s immediate family (state the relationship, i.e., spouse, parent, child, brother, or sister)

_____________________________________________________________________________.

g. Other (state the relationship, i.e., bookkeeper or friend)________________________________________________.

Designation-Insert

Jurisdiction and Enrollment/

Signature

Date

Applicable Letter (a.-g.)

Bar Number, if applicable

Thus Sworn to and Subscribed Before Me, Notary, in the presence of the undersigned two witnesses, who personally came

Form R-7006 - Power Of Attorney And Declaration Of Representative Page 2

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