MONTANA
POA
CLEAR FORM
Rev 03 15
Power of Attorney
Authorization to Disclose Information
Please type or print. See instructions on page 3.
File online at revenue.mt.gov on TAP.
PART I
Caution! Any taxpayers who would like to designate someone else to represent him or her before the Department
of Revenue must complete and submit this form. Spouses filing a joint return must each complete a separate
form.
This form will not be honored for any purpose other than representation before the Department of Revenue. This form cannot be
used for any other purpose other than designating representation before the Department of Revenue.
Notice: The department will accept federal Form 2848 as creating a power of attorney for representation before the Department of
Revenue if the form is completed and in Part I, Section 3, Matters, the taxpayer identifies “Montana” and the type of tax, tax form
number, and year(s) or period(s) that the representative is authorized to discuss with the Department of Revenue. If you use the federal
form, you must provide a copy to the Department of Revenue.
1.
Taxpayer Information. Taxpayers must sign and date this power of attorney form on page 2, section 6.
Taxpayer Name and Address
Taxpayer Identification Number(s)
Telephone Number
hereby appoints the following representative(s) as attorney(s)-in-fact:
2.
Representative(s) See page 2 Part II to sign.
Name and Address
PTIN
Telephone Number
FAX Number
Email Address
Name and Address
PTIN
Telephone Number
FAX Number
Email Address
to represent the taxpayer before the Montana Department of Revenue for the following matters:
3.
Tax Matters and Tax Years Covered by This Form
Your representative is authorized to inspect, receive and discuss confidential information for the tax types and tax years you
authorize by checking the appropriate boxes below and inserting the exact tax years. You may include tax periods that end no later
than three years after the date the form was received by Department of Revenue. If tax matters and tax periods are not specified,
you are authorizing the representative access to all tax matters and years until you revoke such authorization.
Insert exact tax years
Insert exact tax years
q Individual Income Tax
_________________
Rental Vehicle Tax
___________________
q
q Corporation Income Tax
_________________
Withholding Tax
___________________
q
q S Corporation
_________________
Lodging Facilities Tax
___________________
q
q Partnership
_________________
Combined Oil and Gas Tax
___________________
q
Other, please specify below ___________________
q
__________________________________________
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