Form 01-137 - Limited Power Of Attorney
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1STATE OF TEXAS
§
§
COUNTY OF __________________
§
LIMITED POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS that I, _____________________________ (Taxpayer)
of ____________________________________ (Company name), hereby make, constitute, and appoint
(Taxpayer representative), as my true and lawful attorney in fact for me
and in my name, place and stead; for the following purposes only:
To seek a refund of Texas _________________ taxes for the periods of ____________ through
. This includes the right to request and receive any documentation on file with the
Comptroller of Public Accounts in order to prove my right to a refund, to amend and sign any tax return(s)
originally filed during these time periods, and to receive any and all information pertaining to my refund
request. Modes of communication for requesting and receiving information may include telephone, e-mail,
fax or mail.
Dated this ________ day of _________________ , _________ .
____________________________________________
Signature
____________________________________________
Relationship to Entity (i.e., President, Treasurer)
____________________________________________
Taxpayer number
____________________________________________
Area code/daytime phone number
Form 01-137 (Rev.3-99/2)
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