Florida Department of Revenue POWER OF ATTORNEY and Declaration of Representative See Instructions for additional information. PART I - POWER OF ATTORNEY Section 1. Taxpayer Information. Taxpayer(s) must sign and date this form on Page 2, Part I, Section 8. Federal ID no(s). (SSN*, FEIN, etc.) Taxpayer name(s) and address(es) DR-835 R. 10/11 TC Rule 12-6.0015 Florida Administrative Code Effective 01/12 Florida Tax Registration Number(s) (Business Part. No., Sales Tax No., R.T. Acct No., etc.) Contact person Telephone number ( Fax number ( ) ) The Taxpayer(s) hereby appoint(s) the following representative(s) as attorney(s)-in-fact: Section 2. Representative(s). Each representative must be listed individually, and must sign and date this form on Page 2, Part II. Telephone number ( Fax number ( ) ) ) ) ) Name and address (include name of firm if applicable) E-mail address: Name and address (include name of firm if applicable) Cell phone number ( Telephone number ( Fax number ( E-mail address: Name and address (include name of firm if applicable) Cell phone number ( Telephone number ( Fax number ( ) ) ) E-mail address: Cell phone number ( ) To represent the taxpayer(s) before the Florida Department of Revenue in the following tax matters: Section 3. Tax Matters. Do not complete this section if completing Section 4. Year(s) / Period(s) Tax Matter(s) (Tax Audits, Protests, Refunds, etc.) Type of Tax (Corporate, Sales, Reemployment, formerly Unemployment, etc.) To Appoint a Reemployment Tax (formerly Unemployment Tax) Agent Only. Do not complete Sections 3 and 6 if completing Section 4. By completing this section, an employer (taxpayer) appoints a representative to act as its Florida reemployment tax agent before the Florida Department of Revenue on a continuing basis and to receive confidential information with respect to mailings, filings, and other tax matters related to the Florida reemployment assistance program law. All other sections of this form (except Sections 3 and 6) must also be completed. Do not complete Section 4 unless you wish to appoint a reemployment tax agent on a continuing basis. Agent name Firm name Address (if different from above) Agent number (required) Federal I.D. No. (required) Telephone number ( ) Section 4. Mail Type: See Instructions for explanations. Check one box only. 1 (Primary) 2 (Reporting) 3 (Rate) 4 (Claim) Section 5. Acts Authorized. The representative(s) are authorized to receive and inspect confidential tax information and to perform any and all acts that I (we) can perform with respect to the tax matters described in Section 3 and Section 4 (for example, the authority to sign any agreements, consents, or other documents). Except as otherwise provided, the authority specifically includes the power to execute waivers of restrictions on assessment or collection of deficiencies in tax, to execute consents extending the statutory period for assessment or claims for refund of taxes, and to execute closing agreements under section 213.21, Florida Statutes. This authority does not include the power to endorse or cash warrants, or the power to sign certain returns. If you want to authorize a representative named in Section 2 to receive (but not to endorse or cash) refund warrants, write the name of the representative on this line and check the box ........................ ____________________________________________________________________________ List any specific limitations or deletions to the acts otherwise authorized in this Power of Attorney. ______________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com DR-835 R. 10/11 Page 2 Taxpayer Name(s): · · Florida Tax Registration Number: Federal Identification Number: Taxpayer(s) must complete Page 1 of this Power of Attorney or it will not be processed. Section 6. Notices and Communication. Do not complete Section 6 if completing Section 4. Notices and other written communications will be sent to the first representative listed in Part I, Section 2, unless the taxpayer selects one of the options below. Receipt by either the representative or the taxpayer will be considered receipt by both. a. If you want notices and communications sent to both you and your representative, check this box ................................. b. If you want notices or communications sent to you and not your representative, check this box ...................................... Certain computer-generated notices and other written communications cannot be issued in duplicate due to current system constraints. Therefore, we will send these communications to only the taxpayer at his or her tax registration address. Section 7. Retention / Nonrevocation of Prior Power(s) of Attorney. The filing of this Power of Attorney will not revoke earlier Power(s) of Attorney on file with the Florida Department of Revenue, even for the same tax matters and years or periods covered by this document. If you want to revoke a prior Power of Attorney, check this box ............................................................................................................................................... You must attach a copy of any Power of Attorney you wish to revoke. Section 8. Signature of Taxpayer(s). If a tax matter concerns a joint return, both husband and wife must sign if joint representation is requested. If signed by a corporate officer, partner, member/managing member, guardian, tax matters partner/person, executor, receiver, administrator, trustee, or fiduciary on behalf of the taxpayer, I declare under penalties of perjury that I have the authority to execute this form on behalf of the taxpayer. Under penalties of perjury, I (we) declare that I (we) have read the foregoing document, and the facts stated in it are true. If this Power of Attorney is not signed and dated, it will be returned. _______________________________________________________________________________________ Signature _______________________________________________________________________________________ Print name _______________________________________________________________________________________ Signature _______________________________________________________________________________________ Print name ___