Form Dr 0145 - Tax Information Designation And Power Of Attorney For Representation
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3DR 0145 (12/09/13)
*130145==19999*
COLORADO DEPARTMENT OF REVENUE
Taxation Business Group
Denver, CO 80261-0009
Tax Information Designation and
Office Use Only
Date Received:
Power of Attorney for Representation
Taxpayer Last Name or Business Name
First Name
Middle Initial SSN, CAN or FEIN
Spouse’s Last Name, if returns are filed jointly
First Name
Middle Initial SSN or CAN
Address
City
State
Zip
Mark only one (the department will accept the federal form 2848, Power of Attorney and Declaration of Representative, in lieu of this document):
Tax Information Authorization: Marking this box allows the
Power of Attorney for Representation: Mark this box if you want
department to disclose your confidential tax information to
a person to “represent” you. This means the person may receive
your designee. You may designate a person, agency, firm or
confidential information and may make tax decisions on your behalf.
organization. See Section 39-21-113 (4) (b).
For
All Tax years or
Specific tax years/filing periods:
I hereby appoint the following person as Designee for Tax Information or Attorney for Representation:
Last Name
First Name
Middle Initial
Mailing Address
Phone Number
(
)
City
State
Zip
Fax Number
(
)
Name of business/firm (if applicable)
Representative’s title or relationship to taxpayer
Last Name
First Name
Middle Initial
Mailing Address
Phone Number
(
)
City
State
Zip
Fax Number
(
)
Name of business/firm (if applicable)
Representative’s title or relationship to taxpayer
The above-named is authorized to receive my confidential information and/or represent me before the Colorado
Department of Revenue for:
All tax matters until this authorization is revoked in writing, or
Specific tax matters as follows (mark all that apply):
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