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Power Of Attorney And Declaration Of Representative - Government Of The District Of Columbia

GOVERNMENT OF THE DISTRICT OF COLUMBIA

Office of the Chief Financial Officer

Office of Tax and Revenue

POWER OF ATTORNEY AND DECLARATION OF REPRESENTATIVE

Power of Attorney

Taxpayer name(s) and address

Social Security #

FEIN #

Daytime Phone #

Hereby appoint(s) the following representative(s) as attorney(s)-in-fact:

Representative(s) (Representatives(s) must sign and date)

Name and address

Enrollment #

Telephone #

Fax #

Name and address

Enrollment #

Telephone #

Fax #

To represent the taxpayer(s) before the Office of Tax and Revenue for the following tax matters:

Tax matters

Type of Tax (Income,

Tax Form # (D-40,

Year(s) or

Statute of Limitations

Sales, etc.)

D-20 etc)

Period(s)

Expiration Date

Acts authorized. The representatives 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 for example, the authority to sign any agreements, consents, other documents.

List any specific additions or deletions to the acts otherwise authorized in this power of attorney:

______________________________________________________________________________

Notices and communications. Original notices and other written communications will be sent

to you and a copy to the first representative listed unless you check the box below.

If you do not want any notices or communications sent to your first representative, check here

Power Of Attorney And Declaration Of Representative - Government Of The District Of Columbia