Form Rev184a - Election For Power Of Attorney

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REV184a
Election for Power of Attorney
To have Appointee Receive All Correspondence from the Department of Revenue
You may elect to have the Minnesota Department of Revenue send to your power of attorney any and all refunds,
legal notices, and correspondence relating to your tax matters and to your nontax debts referred to the department
for collection. This election is effective only for the authority you have granted to your appointee. If you make this
election, you will no longer receive anything from the department—including refunds—and your appointee will receive
it all on your behalf.
To make this election, complete and attach this form to the Power of Attorney (Form REV184) granting powers to the
appointee. If Form REV184 is not attached, the department will deny your election, and the form will be returned to
you.
This election will expire on the designated expiration date or when you revoke the power of attorney, whichever is
earlier.
Taxpayer’s name (person or business)
Social Security or MN tax ID number (or federal ID number)
Spouse’s name (if a joint return)
Spouse’s Social Security number (if a joint return)
Street address
Check one
(see instructions):
Original—your first election for this
appointee
City
State
Zip code
Amend—changes an existing election
for this appointee
Expiration date of election
Month
Day
Year
(If a date is not provided, this election is
Cancel/Revoke—cancels a previously
valid until the power of attorney is revoked.)
filed election
I elect to have the Minnesota Department of Revenue directly send to the following attorney-in-fact any and all refunds, legal notices
and correspondence relating to my tax matters and to my nontax debts referred to the department for collection. By making this
election, I understand that I will no longer receive anything—including refunds and legal notices—from the department and my ap-
pointee will receive it all on my behalf.
Name of person (appointee) given power of attorney
Name of firm (if applicable)
Street address
City
State
Zip code
Phone number
FAX number
This election is not valid until the form is signed and dated.
Taxpayer’s signature or signature of corporate officer, partner or fiduciary
Print name (and title, if applicable)
Date
Phone
Spouse’s signature (if joint)
Print spouse’s name (if joint)
Date
Phone
Phone: 651-296-3781 or 1-800-652-9094. TTY: Call 711 for Minnesota Relay
Attach this form to Form REV184 and submit to the Department of Revenue using one of the following methods:
• Attach in a secure email to MNDOR.POA@state.mn.us;
• FAX to 651-556-5210; OR
• Mail to Minnesota Revenue, Mail Station 4123, St. Paul, MN 55146-4123
(Rev. 10/12)

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