Form Poa - Authorization To Disclose Tax Information - 2007
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1
2MONTANA
Form POA
Clear Form
New 09/07
Power of Attorney (POA)
Authorization to Disclose Tax Information
1. Purpose of this Form
This form is used by taxpayers to either change a Power of Attorney status or provide written authorization to a
representative.
q
Check this box if you are changing a current Power of Attorney status.
If you are providing authorization to another individual, check the box that best describes what authorization you are
providing to your representative.
q
Representation. Department employees can provide confidential tax information to the representative and discuss
the information. (This is the most frequent response.)
q
Information sharing. Department employees can provide confidential tax information to the representative, but
cannot discuss the information.
q
Decision making authority. Department employees can provide confidential information to a representative,
can discuss the information and the representative can act on the taxpayer’s behalf for all purposes, including
settlement and waiver of appeal rights.
2. Taxpayer Information
Name of Taxpayer(s) or Contact Person
SSN or FEIN
Address
City
State
Zip Code
Telephone Number
Fax Number
E-mail Address
3. Authorization of Representative
Name of Representative
Name of Firm (if applicable)
Address
City
State
Zip Code
Telephone Number
Fax Number
E-mail Address
4. Retention/Revocation of Prior Power(s) of Attorney
q
Check this box if you are substituting one representative for another representative on file with the Montana
Department of Revenue for the same tax matters and year(s)/period(s) covered by this document. Checking this
box will revoke the authorization for the original representative.
q
Check this box if you do not want to revoke a prior authorization and are adding another representative. You must
attach a copy of any Authorization to Disclose Tax Information you want to remain in effect.
q
Check this box if you want to revoke all prior authorizations made on your behalf.
If you are a representative and want to revoke an existing POA, simply write REVOKE across the top of the form, sign
the form in section 6 and file the form as indicated in section 7.
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