Form 151 - Authorized Representative Declaration (Power Of Attorney) Page 2
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2PART 4: TYPE OF AUTHORIZATION
This form is not a written request requiring the Department to send
(Check box A or B.)
copies of letters or notices regarding a dispute to your authorized representative (see MCL 205.8 of 1941 PA 122 and at R.205.1006(8)
for further details).
IMPORTANT: After granting either Limited Authority (check box A) or Unlimited Authority (check box B), you must initial next to the appropriate box in
the space provided, acknowledging the fact that you understand the authority you are granting.
To RESTRICT AUTHORIZATION: Check the Limited Authorization box (check box A) and check the appropriate numbered boxes below. To further limit
authority, indicate the type of tax or debt, type of form, and tax period for which you are granting authority in the Specific Limits table below. To grant
Unlimited Authorization, skip to the Unlimited Authorization section below, check box B, and initial. DO NOT check both box A and box B; that would
invalidate your request.
LIMITED AUTHORIZATION
________ Initial if Selected
A.
To further limit authority, check the appropriate boxes and utilize the Specific Limits table below to indicate the specifics of the limited authorization.
1. Receive, inspect and provide confidential information
2. Represent me and make oral or written presentation, of fact or argument
3. Sign returns
4. Enter into agreements
Specific Limits:
Tax, Debt Type or Fee
Form Type or Assessment Number
Year(s) or Period(s)
(MI-1040, MI-1040CR, 165, etc.)
(Income, Business Tax, Sales, Driver Responsibility Fee, etc.)
To grant UNLIMITED AUTHORIZATION: Check the box below to allow unlimited access to your account by your representative.
UNLIMITED AUTHORIZATION ________ Initial if Selected
B.
Checking Box B, authorizes my representative to do all of the following: (1) receive and inspect and provide confidential information,
(2) represent me and make oral or written presentations of fact and/or argument, (3) sign returns, and (4) enter into agreements. This
authorization applies to all tax, benefit, and debt matters, all form types or assessment numbers, and for all years or periods.
PART 5: TAXPAYER SIGNATURE
By signing this form, I am appointing my authorized representative to perform the specific functions listed above on my behalf with the State of
Michigan.
Signature (Required)
Print Name and Title (Required)
Date (Required)
Spouse’s Signature
Print Name and Title
Date
If you are an individual taxpayer (not representing a business), mail or
If the Treasury Collection Division or Michigan Accounts
Receivable Collection System (MARCS) has requested you to file
fax this form to:
Michigan Department of Treasury
this form, mail or fax the form and any attachments to:
Customer Contact Center, Individual Correspondence Section
MARCS
P.O. Box 30058
P.O. Box 30158
Lansing, MI 48909
Lansing, MI 48909-7658
Fax: (517) 636-4488
Fax: (517) 272-5562
If a Treasury field office representative has requested you to file this form, mail or fax it to that representative.
All others, mail or fax this form to the Registration Section:
Michigan Department of Treasury
Customer Contact Center
Registration Section
P.O. Box 30778
Lansing, MI 48909-8278
Fax: (517) 636-4520
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