Tc-737 - Power Of Attorney And Declaration Of Representative
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Utah State Tax Commission
TC-737
210 N 1950 W, SLC, UT 84134 • tax.utah.gov • 801-297-2200 • fax: 801-297-3573
Rev. 7/15
Power of Attorney and Declaration of Representative
1. Taxpayer Information
(Provide information for only one taxpayer per form)
Name
Identification number(s)
Address
Daytime telephone number(s) Fax number
City
State
ZIP Code
Email address
2. Representative(s)
I hereby appoint the following representative(s) as attorney(s)-in-fact: (attach additional pages if needed)
Name and address
Telephone:
Fax number:
Email:
Name and address
Telephone:
Fax number:
Email:
3. Tax matter(s)
This declaration authorizes the representative(s) to receive and inspect my confidential tax information and, to the extent not limited in
section 4 below, to perform any acts that I can with respect to the tax matter(s) listed below in this section. This power does not include
the power to receive funds, substitute or appoint another representative, or disclose confidential tax information to other parties.
Tax Type
Social Security/Account Number
Year(s) or Period(s)
Appeal Number(s)
_ _ __ _ __
_ _ _ __ ___ ___ __ ___ _
__________
_________________ __ _
_ _ __ _ __
_ _ _ __ ___ ___ __ ___ _
__________
_________________ __ _
_ _ __ _ __
_ _ _ __ ___ ___ __ ___ _
__________
_________________ __ _
4. Acts NOT Authorized
(Check only the boxes of those acts for which authority is NOT given)
My representative(s) is NOT authorized to perform the following acts which would otherwise be authorized:
Sign returns
Amend returns
Negotiate agreements
Sign agreements/consents/similar documents
Reallocate payments between tax types/periods
Represent me in adjudicative proceedings before the Commission
Facilitate audits
Other: ___ __ ___ _________________________________ _ __ __ _
5. Authorized Signature
Unless you check the box below, filing this power-of-attorney will revoke all earlier power(s)-of-attorney on file with the Tax Commission
for the same matters and years/periods covered in this document.
Check this box if you do not wish to revoke all prior power(s)-of-attorney.
_ ___ __ _ __ _ _ __ _ ___ ___ __ ___ __________________
_________ __ __ _
Taxpayer signature
Date
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.
_ ___ __ _ __ _ _ __ _ ___ ___ __ ___ _
_______________
__________ __ _ _
Representative signature
Title
Date
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