Form C-42 - Written Authorization printable pdf download

Form C-42 - Written Authorization

Mail To:

Cashier - Texas Workforce Commission

P.O. Box 149037

Austin, TX 78714-9037

512.463.2731

TWC Website:

WRITTEN AUTHORIZATION

To represent employing unit in its relations with the Texas Workforce Commission

GRANTOR INFORMATION

CONTACT NAME:

TWC ACCT NO.

PHONE NO.

FEID NO.

BY THIS INSTRUMENT,

*(5)

(Name of Grantor)

an employing unit which is a/an

(6)

(Individual, Partnership, or Corporation, etc.)

whose address is

(7)

(Grantor’s current mailing address)

appoints

*(8)

(Name of Authorized Grantee)

whose TWC ACCOUNT NO. is

(9)

and whose address is

its lawful representative to represent it in its relations with the Texas Workforce Commission, and

specifically authorizes said representative to transact any and all business as between

grantor of said authorization and said Commission to do any and all acts necessary,

excluding litigation in court.

This Written Authorization shall be in full force and effect until such time as a Revocation of

Written Authorization, Form C-43, revoking it is filed in the office of said Commission at

Austin, Texas. (Revocable by either party, the Grantor or Grantee.)

*(10)

Printed name, signature and title (Owner, Partner, Officer, etc.) of person signing for Grantor.

Date Signed

*(11)

Form C-42 - Written Authorization