Form Poa-1 - Power Of Attorney - Indiana Department Of Revenue
Download a blank fillable Form Poa-1 - Power Of Attorney - Indiana Department Of Revenue in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Poa-1 - Power Of Attorney - Indiana Department Of Revenue with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3POA - 1
Indiana Department of Revenue
State Form 49357
POWER OF ATTORNEY
(R4 / 4-13)
1. Taxpayer Information
Taxpayer(s) Name(s)
DBA Name(s) (if applicable)
☐
Address
New Address?
City
State
Zip Code
Telephone Number
2. Identification Numbers
Indiana Taxpayer Identification Number (10 digits)
or
Employer Identification Number
—
Social Security Number
Spouse’s Social Security Number
Hereby appoint(s) the following:
3. Representative Information
Additional Individual Representative Name
Individual Representative Name
Address
Address
City
State
Zip Code
City
State
Zip Code
Telephone Number
Email
Telephone Number
Email
Additional Individual Representative Name
Additional Individual Representative Name
Address
Address
City
State
Zip Code
City
State
Zip Code
Telephone Number
Email
Telephone Number
Email
4. Firm/Vendor Information
Firm/Vendor Name (if applicable)
Address
City
State
Zip Code
Telephone Number
Email
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial