Fillable Alaska Power Of Attorney printable pdf download

Alaska Power Of Attorney

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775_

Alaska

POA

Power of Attorney

EIN

Telephone Number

SSN

Taxpayer Name

Fax Number

Mailing Address

City

State

Zip

INDIVIDUAL

PARTNERSHIP

CORPORATION

LIMITED LIABILITY CORPORATION

OTHER

I hereby appoint: [enter below the names(s), addresses (including zip codes), telephone numbers and facsimile numbers of

individual appointee(s). Appointees must sign the declaration on page 2.]

Appointee Name(s)

Appointee Firm

Appointee Address

City

State

Zip

City

State

Zip

Telephone Number

Fax Number

Telephone Number

Fax Number

as attorney-in-fact to represent the taxpayer with respect to the following Alaska tax matters [specify each type of tax and year or period]:

The attorney-in-fact shall, subject to revocation, have authority to receive confidential information and full power and authority to

perform on behalf of the taxpayer all acts with respect to the above tax matters except as follows:

(Strike through any of the following powers which are not granted.)

To represent the taxpayer in administrative proceedings.

To receive, but not to endorse and collect, checks in payment of any refund of Alaska Department of Revenue taxes, penalties, or

interest.

To execute waivers (including offers of waivers) of restrictions on assessment or collection of deficiencies in tax and waivers of

notice of disallowance of a claim for credit or refund.

To execute consents extending the statutory period for assessment or collection of taxes.

To execute closing agreements and stipulations.

To delegate authority or to substitute another representative.

Other powers not granted: (Specify)

Assessments and decisions in proceedings involving the above matters should be sent to (Check one)

Taxpayer

Attorney-in-fact

This power of attorney revokes all prior powers of attorney filed with respect to the same matters and years or periods covered by this

instrument, except the following (Specify and attach copies of the powers of attorney)

Signature of Taxpayer If signed by a corporate officer, partner, or fiduciary on behalf of the taxpayer, I certify that I have the authority to execute this

power of attorney on behalf of the taxpayer.

Signature

Title, If Applicable

Date

Printed Name

Printed Title

775_

THE ORIGINAL MUST BE FILED WITH THE DEPARTMENT

POA

0405-775_POA Rev 08/12 - page 1