Form 10-341 - Crude Oil And Natural Gas Tax Limited Power Of Attorney

Download a blank fillable Form 10-341 - Crude Oil And Natural Gas Tax Limited Power Of Attorney in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 10-341 - Crude Oil And Natural Gas Tax Limited Power Of Attorney with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

RESET FORM

PRINT FORM

STATE OF TEXAS

COUNTY OF __________________

CRUDE OIL AND NATURAL GAS TAX

LIMITED POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENT that I, ______________________________ (Taxpayer)

of ____________________________________ (Company name), hereby make, constitute, and appoint

_________________________ (Taxpayer representative), as my true and lawful attorney in fact for me

and in my name, place and stead; for the following purposes only:

To seek a refund of Texas Crude Oil and/or Natural Gas taxes for the periods of _____________ through

______________ . This includes the right to request and receive any documentation on file with the

Comptroller of Public Accounts in order to prove my right to a refund, to amend and sign any tax report(s)

originally filed during these time periods, to sign transfer forms, and to receive any and all information

pertaining to my refund request. Modes of communication for requesting and receiving information may

include telephone, e-mail, fax or mail.

Check all that apply:

Allow to file tax reports and access account data for Crude Oil Tax for the tax periods of

_______________ through _______________ . The date range begins with the signature date

indicated below through _______________ .

Allow to file tax reports and access account data for Natural Gas Tax for the tax periods of

_______________ through _______________ . The date range begins with the signature date

indicated below through _______________ .

This Crude Oil and Natural Gas Tax Limited Power of Attorney is effective no longer than one year

from the signature date.

Dated this ______________ day of __________________ , _________ .

TAXPAYER REPRESENTATIVE INFORMATION

TAXPAYER INFORMATION

______________________________________

_______________________________________

11-digit Texas taxpayer number (if assigned)

Print name

______________________________________

_______________________________________

Taxpayer representative name (Print)

Signature

______________________________________

_______________________________________

Mailing address

Relationship to entity (i.e., President, Treasurer)

______________________________________

_______________________________________

City, State, ZIP code

11-digit Texas taxpayer number

______________________________________

_______________________________________

Daytime phone (Area code and number)

You have certain rights under Chapters 552 and 559, Government Code, to review, request, and correct

information we have on file about you. To request information for review or to request error correction, contact us at the toll-free number listed on this form.

Form 10-341 (12-07)