POWER OF ATTORNEY KNOW ALL PERSONS BY THESE PRESENTS: THAT, ________________________________, GA DOL Account No. ___________________, having its principal office at ______________________________________________, hereby appoints ____________________________ as its true and lawful agent with full authority to represent the said __________________________ before the Georgia Department of Labor, until further notice, in connection with all matters affecting State Unemployment Insurance Taxes including, without limitation, all claims, tax contributions and experience ratings. This Power of Attorney supersedes and revokes any prior power of attorney authorization from the named employer relating to the subject matter hereof. The undersigned warrants that he or she is authorized to execute this Power of Attorney. IN WITNESS WHEREOF, the undersigned has duly executed and delivered this Power of Attorney on behalf of the named employer this _____ day of __________________ 20____. ___________________________________ Employer's Name By: ___________________________________ Signature ___________________________________ Print or Type Name ___________________________________ Title It is respectfully requested that all forms pertaining to unemployment taxes be mailed to the new ADDRESS OF RECORD as indicated below. American LegalNet, Inc. www.FormsWorkFlow.com