Power Of Attorney Individual Or Sole Proprietor {184I}

REV184 Power of Attorney Taxpayer Information Read the instructions on the back before completing this form. Taxpayer's name (person or business) Spouse's name (if a joint income tax return) Street address Social Security or Minnesota tax ID number (or federal ID number) Spouse's Social Security number (if a joint income tax return) City State ZIP code Check only one (see instructions): Power of Attorney Add--appoints a new power of attorney authorizing the appointee(s) Change--changes an existing power of attorney for the appointee(s) Remove--ends the power of attorney for the appointee(s) Primary appointee: Name of person given power of attorney Street address Phone number City Fax number State Email address ZIP code Ifremovinganappointee,skipthenexttwosections,thensignanddatetheform. I appoint the above person, and anyone included on the attachment, as attorney-in-fact to represent me before the Minnesota Department of Revenue. It is my responsibility for determining if the person I appoint as my Power of Attorney (POA) is eligible to practice before the department under Minnesota Rules 8052.0300 and to keep my appointee informed of my tax and my nontax debt matters referred to the department for collection. I understand the department does not send copies of all correspondence to my appointee. (For exception, see %22Optional Elections%22 below.) I grant full authority to the appointee(s). The appointee(s) is authorized to perform all acts I can perform with my tax and nontax debt matters referred to the Department of Revenue for collection. Authority Granted Check this box if the appointee(s) is not authorized to sign tax returns. Igrantlimitedauthorityforspecifictaxtypes,periodsand/orduties(check only the boxes that apply). By checking the boxes, the appointee(s) will be authorized to act on my behalf only for the indicated tax matters. If I do not indicate a specific year or period for a selected tax type, I am granting authority for all years or periods. Check this box if the appointee(s) is not authorized to sign the return(s) for the tax matters indicated below. Taxtype Individual Income Tax Property Tax Refund Nontax Debts Business Income Taxes (Corporate Franchise Tax, Fiduciary Income Tax, Partnership Tax, S Corporation Tax, and Unrelated Business Income Tax) Yearsorperiods Taxtype Sales and Use Tax Withholding Tax MinnesotaCare Taxes Other (describe below) Yearsorperiods Check any that apply (see instructions): Authorizeprimaryappointeetoreceiveallcorrespondence,includingrefunds,fromthedepartment. I elect to have the Minnesota Department of Revenue send the primary appointee all refunds, legal notices, and correspondence about the tax and nontax debt matters specified in this document. By making this election, I understand that I will no longer receive anything--including refunds and legal notices--from the department and my primary appointee will receive it on my behalf. Optional Elections Authorize appointee to communicate by email. I authorize the Minnesota Department of Revenue to communicate by email with my appointee(s). I understand private tax data about me will be sent over the Internet. I accept the risk my data may be accessed by someone other than the intended recipient. I agree the Minnesota Department of Revenue is not liable for any damages I may have as a result of interception (have the appointee sign on the line below). Appointee signature (for email authorization) Date Signature and Expiration ExpirationDate (If a date is not provided, this power of attorney and optional elections are valid until removed.) Month Day Year Thispowerofattorneyandelectionsarenotvaliduntilsignedanddatedbythetaxpayer. Taxpayer's signature (or corporate officer, partner or fiduciary) Spouse's signature (if joint income tax return) Print name (and title, if applicable) Print spouse's name Date Date Phone Phone (Rev. 1/17) Send a signed copy of this form to the department: In a secure email to MNDOR.POA@state.mn.us, by fax to 651-556-5210, or by mail to Minnesota Revenue, Mail Station 4123, St. Paul, MN 55146-4123 American LegalNet, Inc. www.FormsWorkFlow.com Form REV184 Instructions What is a Power of Attorney (POA)? Appointee A power of attorney (POA) is a legal document authorizing someone to act as your representative or appointee. It grants your appointee power to act on your behalf. It also allows your appointee to discuss your private tax and nontax debt matters with the Minnesota Department of Revenue. The appointee is the person that you are selecting to represent you before the department. The person you appoint must be eligible to practice before the Department of Revenue. (See Minnesota Rules 8052.0300.) The following people cannot act as your POA: · A person barred or suspended from practice before the department · A person barred or suspended from practice as an attorney or CPA in Minnesota · A person barred or suspended from practice before the Internal Revenue Service · An employee of the department · A former Revenue employee within 1 year of leaving the department Note: You are responsible to keep your appointee informed of your tax and nontax debt matters. The department does not routinely send all documents to the designated appointee. For exceptions, see the Optional Elections section. · Your situation is not specific to a tax type, year, or period, such as an administrative appeal, audit, or collection matter. Describe the situation(s) on the line below. Optional Elections When do I use this form? To give, change, or take away authority of an attorney, accountant, agent, tax return preparer or other person to represent you before the department. Send all department correspondence to the primary appointee You can choose to have the department send all refunds, legal notices, correspondence, and tax information directly to the primary appointee. This election is effective only for the authority you have granted to your primary appointee. To make this election, check the box for %22Authorize primary appointee to receive all correspondence, including refunds, from the department.%22 Note: If you make this election, you will no longer receive anything from the department and your primary appointee will receive it all on your behalf, including any refunds. Communicate by email If you would like the department to communicate by email with your appointee: · Check the optional election box for %22Authorize appointee to communicate by email%22 · Have your appointee sign