Form 2827 - Power Of Attorney - 2016
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Department Use Only
Missouri Department of Revenue
Form
(MM/DD/YY)
2827
Power of Attorney
Taxpayer Missouri
Taxpayer Federal
Tax I.D. Number
Employer I.D. Number
*14504010001*
Taxpayer Social
Security Number
14504010001
All appointed representatives must sign on reverse side of this form.
Taxpayer’s Name or Business Name
Spouse’s Name or if a dba, state the business name
Spouse’s Social Security Number
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Street Address
Missouri Charter Number
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City
State
Zip Code
Telephone Number
(__ __ __) __ __ __ - __ __ __ __
E-mail Address
Name of Appointed Representative
Address
Telephone Number
E-mail Address
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Name of Appointed Representative
Address
Telephone Number
E-mail Address
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Name of Appointed Representative
Address
Telephone Number
E-mail Address
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Name of Appointed Representative
Address
Telephone Number
E-mail Address
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Cigarette or Other Tobacco Products
Corporation Income and Corporation Franchise
Personal Income
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Motor Fuel
Sales or Use
Withholding
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Other
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All Tax Periods
Tax Year or Period(s) Only ___________________________________________
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Range of Tax
Date of Death (if estate tax) ___ ___ / ___ ___ / ___ ___ ___ ___
Tax Period Beginning ___ ___ / ___ ___ / ___ ___ ___ ___ to Tax Period Ending ___ ___ / ___ ___ / ___ ___ ___ ___
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All other powers of attorney on file with the Department shall remain in effect, or
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By execution of this power of attorney, all earlier powers of attorney on file with the Department are hereby revoked, except the
following: (specify to whom the power of attorney was granted, date and address, or refer to attached copies of earlier powers of attorney
and authorizations.) Attach additional forms if needed.
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Parent category: Financial