Kansas Department Of Revenue Power Of Attorney Page 2
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1
2INSTRUCTIONS FOR POWER OF ATTORNEY AUTHORIZATION
A power of attorney is a legal document authorizing someone to act as your representative. You - the taxpayer
must complete, sign, and return this form if you wish to grant a power of attorney (POA) to an attorney, accountant,
agent, tax return preparer, family member, or anyone else to act on your behalf with the Kansas Department of
Revenue. You may use this form for any matter affecting any tax administered by the department, including audit
and collection matters. This POA will remain in effect until the expiration date, if included under Section 2, or until
you revoke it, whichever is earlier. The department will accept copies of this form, including fax copies.
Retention/revocation of prior powers of attorney.
INSTRUCTIONS
Unless otherwise specified, this POA replaces and
revokes all previous POAs on file with the department.
S
1. T
I
.
ECTION
AXPAYER
NFORMATION
If there is an existing POA that you do NOT want to
revoke, check the box in this section and attach a
Individuals. In the block provided, enter your name,
copy of each POA that will remain in effect.
SSN, address, and telephone number in the spaces
If you wish to revoke an existing POA without
provided. If this POA is for a joint return and your
naming a new representative, attach a copy of the
spouse is designating the same representative or
previously executed POA.
On the copy of the
representatives, enter your spouse’s name and Social
previously executed POA, write “REVOKE” across the
Security number, and your spouse’s address if
top of the form, and initial and date it again under your
different from your own.
signature or signatures already in Section 3.
Businesses. Enter both the legal name and the DBA
or trade name, if different.
For example, if the
S
3. S
T
T
.
business is an individual proprietorship, enter the
ECTION
IGNATURE OF
AXPAYER OR
AXPAYERS
proprietor's name and the name under which business
is transacted. (e.g., Joe Smith dba Joe's Diner). Also
You must sign and date the POA. If a joint return is
enter the EIN (federal employer identification number),
being filed and both husband and wife intend to
the business address, and telephone number.
authorize the same person to represent them, both
Estates. Enter the name, title, and address of the
spouses must sign the POA unless one spouse has
decedent’s executor/personal representative in the
authorized the other in writing to sign for both. You must
taxpayer section. Use the spouse’s section to enter
attach a copy of your spouse's written authorization to
the decedent’s name, date of death, and SSN.
this POA.
S
2. T
P
A
.
ECTION
AXPAYER GRANT OF
OWER OF
TTORNEY
S
4. S
R
ECTION
IGNATURE
OF
EPRESENTATIVE
OR
.
REPRESENTATIVES
Representative's name. For this block, complete all
the requested information for each representative. If
Each representative that you name must sign and
the representative is a member of a firm, enter the
date this form.
firm’s name too. If you are designating more than two
representatives, please complete another form and
QUESTIONS?
attach it to this form. Mark the second form “additional
representatives.”
If you have questions about this form, please visit
Type of tax. For this block, enter the type of tax and
or call our office.
the tax years or reporting periods for each tax type. If
you wish the power of attorney to apply to all periods
Taxpayer Assistance Center
and all tax types administered by the department,
st
Docking State Office Building, 1
Floor
please enter "All tax types" in the block for "Type of
915 SW Harrison St.
Tax" and "All tax periods" in the block for "Year(s) or
Topeka, KS 66612
Period(s)." If the matter relates to estate, inheritance,
Phone: (785) 368-8222
or succession tax, please enter the date of the
Hearing Impaired TTY: (785) 296-6461
decedent’s death.
Authorized acts. Check all boxes that apply. Use
The Department of Revenue office hours are 8:00
the additional lines to limit, clarify, or otherwise define
a.m. to 5:00 p.m., Monday through Friday.
the acts authorized by this POA. For example, if you
wish to limit the POA to a specific time period or to
Additional copies of this form are available from
establish an expiration date, enter that information
our web site at
and the dates (month, day, and year) on these lines.
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