DR 0145 (03/17/11) COLORADO DEPARTMENT OF REVENUE TAXPAYER SERVICE DIVISION 1375 SHERMAN ST DENVER, CO 80261 www.TaxColorado.com POWER OF ATTORNEY For Department-Administered Tax Matters  7D[SD\HU ,QIRUPDWLRQ DQG ,GHQWL¿FDWLRQ Taxpayers must sign on reverse side. Taxpayer Name(s) and address (include any trade name or DBA) Daytime Phone Number Social Security Number for Individual Second Social Security Number (if using jointly) or Colorado Tax ID Number(s) 2. Representative(s). Representative(s) must sign on reverse side. Hereby appoint(s) the following representative(s) as attorney(s)-in-fact: A. Name(s) and address Phone Number Fax Number Attorney Reg Number or FEIN (if applicable) B. Name(s) and address Phone Number Fax Number Attorney Reg Number or FEIN (if applicable) 3. Tax matters approved for representation: … State Sales Tax … All Department Administered Sales Taxes Period From ___________ To ___________ … State Consumers Use Tax … All Dept. Administered Consumers Use Taxes Period From ___________ To ___________ … Individual Income Tax Period From ___________ To ___________ … Corporate Income Tax … Other (specify) … Wage Withholding Period From ___________ To ___________ … Other Tax (specify) Period From ___________ To ___________ … All Taxes within the scope of §39-21-102, C.R.S. Period From ___________ To ___________  $FWV $XWKRUL]HG ² 7KH UHSUHVHQWDWLYHV DUH DXWKRUL]HG WR UHFHLYH DQG LQVSHFW FRQ¿GHQWLDO WD[ LQIRUPDWLRQ DQG UHFRUGV DQG WR SHUIRUP DQ\ DQG DOO acts that the taxpayer named above can perform with respect to the tax matters described in number 3, for example, the authority to sign and bind the taxpayer above to agreements, consents, or other documents. The authority does not include the power to receive refund checks or the deleted DFWV VSHFL¿FDOO\ DGGUHVVHG EHORZ  $GGHG RU 'HOHWHG $FWV ² /LVW DQ\ VSHFL¿F DGGLWLRQV RU GHOHWLRQV WR WKH DFWV RWKHUZLVH DXWKRUL]HG LQ WKLV SRZHU RI DWWRUQH\ BBBBBBBBBBBBBBBBBBBBB _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com  5HWHQWLRQ5HYRFDWLRQ RI 3ULRU 3RZHUV RI $WWRUQH\ ² 7KH ¿OLQJ RI WKLV SRZHU RI DWWRUQH\ DXWRPDWLFDOO\ UHYRNHV DOO HDUOLHU SRZHUV RI DWWRUQH\ RQ ¿OH ZLWK WKH &RORUDGR 'HSDUWPHQW RI 5HYHQXH IRU WKH VDPH WD[ PDWWHUV DQG SHULRGV FRYHUHG E\ WKLV GRFXPHQW ,I \RX GR not want to revoke a prior power of attorney, check here .......................................................................................................................................... … YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT. 7. Signature of Taxpayer(s) — If this form is not signed, dated and titled (if applicable), it is invalid. If tax matters concern a joint return, both parties must VLJQ IRU MRLQW UHSUHVHQWDWLRQ ,I VLJQHG E\ D FRUSRUDWH RI¿FHU SDUWQHU JXDUGLDQ WD[ PDWWHUV SDUWQHU H[HFXWRU UHFHLYHU HVWDWH DGPLQLVWUDWRU RU WUXVWHH on behalf of the taxpayer, I certify that I have the authority to execute this form on behalf of the taxpayer. Signature Date Print Name Title Signature Date Print Name Title  'HFODUDWLRQ RI 5HSUHVHQWDWLYH ², DP DXWKRUL]HG WR UHSUHVHQW WKH WD[SD\HUV LGHQWL¿HG LQ QXPEHU  IRU WKH WD[ PDWWHUV VSHFL¿HG Signature Date Title , UHSUHVHQW WKH WD[SD\HUV LGHQWL¿HG LQ QXPEHU  DV … CO-licensed attorney, Reg Number … Attorney registered in _____________________ … CO-licensed CPA … CPA licensed in _________________________ … Full-time employee of the taxpayer … Enrolled agent __________________________ … Other, explain _________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ Signature Date Title , UHSUHVHQW WKH WD[SD\HUV LGHQWL¿HG LQ QXPEHU  DV … CO-licensed attorney, Reg Number … Attorney registered in _____________________ … CO-licensed CPA … CPA licensed in _________________________ … Full-time employee of the taxpayer … Enrolled agent __________________________ … Other, explain _________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ 3URFHVVLQJ ZLOO EH IDVWHU LI DGGUHVVHG WR D VSHFL¿F VHFWLRQ RI WKH 'HSDUWPHQW DQG LI \RX FDQ DWWDFK FRSLHV RI GRFXPHQWDWLRQ RI WKH LVVXH LQ GLVSXWH VXFK DV D 5HIXQG &ODLP 1RWLFH RI 'H¿FLHQF\ 1RWLFH RI 5HIXQG 'HQLDO )HGHUDO 5HYHQXH $JHQWV 5HSRUW HWF :KHUH WKH DGGUHVV GRHV QRW VSHFLI\ D VHFWLRQ this form will be directed to Taxpayer Service, 1375 Sherman St., Denver, CO 80261. 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