Form Dr 0145 - Tax Information Designation And Power Of Attorney For Representation Page 2
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Period
Period
(MM/DD/YY-MM/DD/YY)
(MM/DD/YY-MM/DD/YY)
–
–
State Sales Tax
Partnership Income Tax
Period
Period
(MM/DD/YY-MM/DD/YY)
(MM/DD/YY-MM/DD/YY)
–
–
State Consumer Use Tax
Withholding Income Tax
Period
Period
(MM/DD/YY-MM/DD/YY)
(MM/DD/YY-MM/DD/YY)
All Department-
Individual Income Tax
–
–
Administered Sales Taxes
Period
Period
(MM/DD/YY-MM/DD/YY)
(MM/DD/YY-MM/DD/YY)
All Department-
Corporate Income Tax
–
–
Administered Consumer Use Taxes
Period
Period
(MM/DD/YY-MM/DD/YY)
(MM/DD/YY-MM/DD/YY)
–
–
Fiduciary Income Tax
Other tax (specify)
If other, please explain
Signature of Taxpayer(s)
I acknowledge the following provision: Actions taken by a Power of Attorney representative are binding,
even if the representative is not an attorney. Proceedings cannot later be declared legally defective
because the representative was not an attorney.
Corporate officers, partners, fiduciaries, or other qualified persons signing on behalf of the taxpayer(s):
I am authorized to sign this form on behalf of the entity or person identified above as the taxpayer because:
• I am the taxpayer
• The taxpayer is a corporation, and I am the corporate officer
• The taxpayer is a partnership, and I am a partner
• The taxpayer is a trust, and I am the trustee
• The taxpayer is a decedent’s estate, and I am the estate administrator
• The taxpayer is a receivership, and I am the receiver
• Other (if none of the above, then explain what representative capacity you have for the taxpayer)
If a tax matter concerns a joint return, both spouses must sign if joint representation is requested. Taxpayers
filing jointly may authorize separate representatives.
Signature
Print Name
Date
(MM/DD/YY)
Title (if applicable)
Daytime telephone number
(
)
Spouse Signature (if joint representation)
Print Name
Date
(MM/DD/YY)
Declaration of Representative — I am authorized to represent the taxpayer(s) identified above for the
tax matter(s) specified.
Signature
Date
Title
(MM/DD/YY)
Note: This authorization form automatically revokes and replaces all earlier tax information designations and/or earlier powers of
attorney for representation on file with the Colorado Department of Revenue for the same tax matters and years or periods covered
by this form. Attach a copy of any other tax information authorization or power of attorney you want to remain in effect.
If you do not want to revoke a prior authorization, taxpayer sign here
Spouse signature if returns are filed jointly
Please complete the following, if known (for routing purposes only). Otherwise, you may mail this document or submit
an electronically scanned copy of the document through Revenue Online,
Revenue Employee
Division
Section
Telephone Number
Fax Number
(
)
(
)
Send to: Colorado Department of Revenue Denver, CO 80261-0009
If this tax information authorization or power of attorney form is not signed, it will be returned.
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