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MISSOURI DEPARTMENT OF REVENUE
POWER OF ATTORNEY
PLEASE TYPE OR PRINT
(Submission of a DOR-2827, Power of Attorney, by a taxpayer is not in itself sufficient as official notice to the
Department of Revenue of an address change.)
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TAXPAYER’S NAME OR BUSINESS NAME
SOCIAL SECURITY NUMBER/FEDERAL I.D. NUMBER
__ __ __ __ __ __ __ __ __
SPOUSE’S NAME OR IF A D/B/A, STATE THE BUSINESS NAME
SPOUSE’S SSN/FEDERAL I.D. NUMBER
__ __ __ __ __ __ __ __ __
STREET ADDRESS
MISSOURI TAX I.D. NUMBER
__ __ __ __ __ __ __ __
CITY OR TOWN, STATE, ZIP CODE
TELEPHONE NUMBER
MISSOURI CHARTER NUMBER
(__ __ __) __ __ __ - __ __ __ __
__ __ __ __ __ __ __ __ __ __
E-MAIL ADDRESS
TAXPAYER(S) HEREBY APPOINTS (Please print or type - attach additional forms if needed)
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NAME OF APPOINTED REPRESENTATIVE
ADDRESS
TELEPHONE NUMBER
E-MAIL
(__ __ __) __ __ __ - __ __ __ __
NAME OF APPOINTED REPRESENTATIVE
ADDRESS
TELEPHONE NUMBER
E-MAIL
(__ __ __) __ __ __ - __ __ __ __
NAME OF APPOINTED REPRESENTATIVE
ADDRESS
TELEPHONE NUMBER
E-MAIL
(__ __ __) __ __ __ - __ __ __ __
NAME OF APPOINTED REPRESENTATIVE
ADDRESS
TELEPHONE NUMBER
E-MAIL
(__ __ __) __ __ __ - __ __ __ __
as attorney(s)-in-fact to represent taxpayer(s) before the Missouri Department of Revenue, with respect to the following tax matter(s) (the tax
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type and year(s) to which this form applies must be listed below):
YEAR(S) OR PERIOD(S)
TYPE OF TAX
MISSOURI TAX FORMS
(DATE OF DEATH IF ESTATE TAX)
A ll Periods
W ithholding
Individual
A ll Forms
T ax Year/Period(s) Only _____________
Sales/Use
M otor Fuel
All Registration Forms
______________ to _______________
C orporate Income/Franchise
Other ________________
Form (s) _______________ Only
Date of death _____________________
Cigarette/Other Tobacco Products
Each attorney-in-fact is authorized, subject to revocation, to receive confidential information and perform any and all acts that the taxpayer(s)
can perform with respect to the above specified tax matters, but not the power to endorse or receive checks in payment of any refunds or to
represent the taxpayer/business in any proceeding before the Administrative Hearing Commission.
Information involving the above tax matter(s) may be sent as indicated below: Failure of representative to receive notice does not relieve the
taxpayer of responsibility to respond to notices.
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1. The representative first named above; or
2. The following named representative(s) (no more than two):
Revocation of prior Powers of Attorney (Must check one of the boxes below)
All other powers of attorney on file with the Department shall remain in effect; or
By execution of this power of attorney, all earlier powers of attorney on file with the Department are hereby revoked, except the following:
(specify to whom the power of attorney was granted, date and address, or refer to attached copies of earlier powers of attorney and a uthori-
zations.) Attach additional forms if needed.
Note: All appointed representatives must sign on reverse side of this form.
DOR-2827 (07-2012)