Form Rd-1061 - Department Of Revenue Power Of Attorney - 2009
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2RD-1061 (REV. 07/03)
(Rev. 10/09)
Department of Revenue
POWER OF ATTORNEY
Print
Clear
STATE OF
COUNTY OF
Know all persons by these presents that
TAXPAYER’S NAME
REGISTRATION OR IDENTIFICATION NO.
ADDRESS
PHONE NUMBER
Hereby appoint(s
)
REPRESENTATIVE’S NAME
ADDRESS
PHONE NUMBER
As attorney(s) –in-fact to represent the taxpayer(s) before the Georgia Department of Revenue for the
following tax matters [Specify the type(s) of tax and year(s) or period(s) (date of death if estate tax)]:
The attorney(s) –in-fact (or either of them) are authorized, subject to revocation, to receive confidential
information and to perform on behalf of the taxpayer(s) the following acts for the above tax matters [Strike
through any of the following which are not granted]:
To receive, but not to endorse and collect, checks in payment of any refund of tax, penalty or interest.
To execute waivers (and related documents) of restrictions on assessment or collection of tax
deficiencies and waivers of any other rights of taxpayer(s).
To execute consents extending the statutory period for assessment, collection or refund of taxes.
To receive all notices pertaining to these tax matters.
To represent taxpayer(s) in conferences and hearings, to file appeals from notices of assessment,
and to execute claims for refund.
To receive confidential information pertaining to these tax matters.
To delegate authority or to substitute another representative.
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