Fillable Form Rev184 - Power Of Attorney (Page 2 of 2) in pdf

Form REV184 Instructions

Purpose

Expiration Date

the designated appointee. Your appointee

might receive certain tax debt documents,

You must complete, sign and return this

If you want the power of attorney to end on a

but not all of them. Therefore, it is your re-

form if you want to grant power of attor-

specific date, fill in the month, day and year.

sponsibility to keep your appointee informed

ney to an attorney, accountant, agent, tax

If a date is not provided, the power of attor-

of your tax matters.

return preparer or any other person as an

ney will remain valid until it is revoked.

attorney-in-fact to perform acts on your

To elect everything to be sent to your

behalf and to discuss with the department

Appointee

power of attorney rather than you

your private tax matters and matters related

State law allows you to make an election in

Fill in the name, address, phone and FAX

to your nontax debts that have been referred

writing to have the department send any and

number of the person and/or firm, organiza-

to the department for collection. A power

all refunds, legal notices, correspondence,

tion or partnership you are appointing to

of attorney is a legal document authorizing

and tax information directly to the appointee

represent you before the department. If you

someone to act as your representative.

rather than you. This election is effective

fill in the name of a person and the name of

only for the authority you have granted to

You may use this form for any matters af-

a firm, you are appointing both that person

your appointee. If you make this election,

fecting any tax administered by the Depart-

and anyone else who is with that firm to

you will no longer receive anything from the

ment of Revenue. This includes both the

represent you. If the person you are naming

department and your appointee will receive

audit and collection processes. You may also

leaves the firm, that person is still consid-

it all on your behalf, including any refunds.

use this form for any matters affecting any

ered to be your appointee, in addition to the

nontax debt that has been referred to the

firm you are naming. At any time after you

To make this election, complete and attach

department for collection.

file this form, if you decide that either the

Form REV184a, Election to Receive All Cor-

person or the firm no longer represents you,

respondence from the Department of Revenue,

This power of attorney will remain in effect

submit another Form REV184 that amends,

to this form.

until the expiration date, if any, or until you

cancels or revokes the original form.

revoke it, whichever is earlier.

Your Signature

Granting Powers

The department will accept copies of this

The power of attorney is not valid until it is

form, including those from a FAX machine.

Check one box to grant full or limited

signed and dated.

authority to the power of attorney. If the

Original, Amend or

Your signature at the bottom of this form

appointee is not authorized to sign your tax

authorizes the individual you designate

Cancel/Revoke

returns, check the appropriate box.

(your representative or “attorney-in-fact”) to

Check one box to indicate your intent for

If you want to grant limited authority, you

perform any act you can perform with the

filing this form.

must indicate the specific tax types, periods

department. This authority includes signing

and/or duties you want the appointee to

consents to a change in tax liability, consents

Original—Check this box if this power

perform. If a specific year or period is not

to extend the time for assessing or collecting

of attorney is new and does not amend or

indicated for a selected tax type, the powers

tax, closing agreements and compromises.

replace any existing power of attorney on

granted will apply to all years and/or peri-

file with the department.

If you are granting authority for a joint re-

ods, both past and future.

If you are appointing a new power of at-

turn, both signatures are required. However,

torney AND canceling another, complete

If your tax situation does not fit into a tax

only one signature is needed if you are grant-

separate Forms REV184 for each task.

type or period (for example, a specific ad-

ing powers for disclosure purposes only.

ministrative appeal, audit or collection mat-

Amend—Check this box if you have an

If you want to exclude granting authority to

ter), describe it in the blank space provided

existing power of attorney on file with the

perform any of these, or other specific acts,

for comments.

department for the appointee and you want

describe those exclusions in the blank space

If you do not want to grant authority to the

to make changes. When you complete this

provided for comments.

form, briefly describe the changes in the

appointee to sign your return, you must

Use of Information

blank space provided for comments.

check the box.

The information collected on this form

Cancel/Revoke—Check this box if you

Nontax Debt Matters

may be private or nonpublic data and, if so,

want to revoke an existing power of attor-

If the department is attempting to collect

cannot be disclosed to the public or other

ney for the appointee that is on file with the

nontax debts referred to it by other public

agencies. It will only be used for tax admin-

department. (Note: It is not necessary for

entities, the appointee is authorized to per-

istration purposes or collection of nontax

you to file this form to revoke a previously

form any and all acts that you can perform

debts. If you do not provide all the requested

filed power of attorney. If you prefer, you

with respect to all these nontax debts, unless

information, your Form REV184 may not be

may revoke an earlier power of attorney by

you specify otherwise. To grant limited

processed.

writing to the department.)

authority regarding nontax debt matters,

If you choose not to cancel/revoke a previ-

Questions?

be sure to check the appropriate box on the

ous power of attorney, you are considered to

front of this form.

Website:

have multiple representatives.

Email:

Individual.IncomeTax@state.mn.us

Election for Appointee to

Phone: 651-296-3781 or 1-800-652-9094

Receive All Correspondence

(TTY: Call 711 for Minnesota Relay)

Please note that as a general rule, the depart-

ment does not routinely send documents to

Form Rev184 - Power Of Attorney Page 2

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