Limited Power Of Attorney Form - Maine Revenue Services printable pdf download

Limited Power Of Attorney Form - Maine Revenue Services

STATE OF MAINE

MAINE REVENUE SERVICES

24 STATE HOUSE STATION

AUGUSTA, MAINE 04333-0024

LIMITED POWER OF ATTORNEY FORM

Please read, ﬁ ll out, and sign this form if you wish to appoint an attorney-in-fact (“AIF”). Your

tax record information kept by MRS is conﬁ dential by law. This includes all returns and ﬁ lings

made by you. This form allows MRS to discuss your tax record information with your AIF. Your

tax records are all your tax information on ﬁ le with MRS.

I understand that my tax records are conﬁ dential under State law.

I authorize my named AIF to discuss information in my tax records with MRS.

I authorize MRS to discuss information in my tax records with my named AIF.

Name of AIF (print):

_________________________________________________

Address of AIF:

_________________________________________________

Ph. Number :

_________________________________________________

Tax Type:

_________________________ Tax Period:______________

Name of Taxpayer (print):___________________________________________________

Date of Birth: __________________________

Social Security Number/Tax ID Number : _____________________________________

Address of Taxpayer :

_________________________________________________

Ph. Number :

_________________________________________________

______________________________________________ _________________________

Taxpayer Signature, Title

Date

NOTICE: This form does NOT revoke other power of attorney forms on ﬁ le with MRS.

Revised 06/11

Limited Power Of Attorney Form - Maine Revenue Services