IN THE OREGON TAX COURT MAGISTRATE DIVISION , ) ) ) Name(s) ) Plaintiff(s) ) versus ) ) COUNTY ASSESSOR, ) Case No. (for court use only) ) NOTE : For property tax cases, if you named the ) Department of Revenue as a defendant on your Complaint, ) check below: ) ) _______ DEPARTMENT OF REVENUE, ) State of Oregon, ) Defendant(s) ) AUTHORIZATION TO REPRESENT Generally, you may represent yourself in an appeal to the Magistrate Division of the Oregon Tax Court. However, entities, such as a corporation, nonprofit or exempt organization, partnership, limited liability company, S corporation, or trust, must be represented. Your representative must meet the requirements of ORS 305.230. See also TCR-MD 1(E). Please check the designation below that applies to your Authorized Representative : Income or Pr oper ty Matter s: ____ An Oregon attorney ____ An Oregon public accountant (includes CPAs and other licensed accountants) ____ An employee of the taxpayer regularly employed by the taxpayer in tax matters ____ A trustee of a trust ____ ____ A designated representative of a nonprofit organization or an organization exempt from taxation ____ A spouse, child who has arrived at the age of majority, or parent of the named party ____ A person with power of attorney from the party being represented Income Tax Matter s Only: ____ An Oregon licensed tax consultant ____ An S corporation may be represented by a shareholder designated as the tax matters shareholder. ____ A partnership may be represented by the tax matters partner Pr oper ty Tax Matter s Only: ____ An Oregon licensed real estate broker or state certified, licensed, or registered appraiser NOTE: For all taxpayer s r epr esented by an author ized r epr esentative other than an attor ney . The Tax Cour t is r equir ed by statute to notify all taxpayer s that you ar e bound by all things done by your r epr esentative. ORS 305.230(4). You should know that you may not later claim that any of the actions of your author ized r epr esentative wer e legally defective because you wer e not r epr esented by an attor ney. ORS 305.230(3). Statement of Author ization to Repr esent ____________________________________________________ is authorized to represent the above-named plaintiff(s) in this appeal. The authorized representative is a(n)__________________________________________. Signature of Taxpayer ____________________________________________________________Date __________ Sign Print Title Name (please print) __________________________________________________________ Address _________________________________ City ________________State ______Zip ____________ Phone ___________________Fax ___________________Email____________________________ 1163 State Street, Salem, OR 97301-2563 http://courts.oregon.gov/tax (503) 986-5660 Fax: (503) 986-4507 Rev. 01/11 American LegalNet, Inc. www.FormsWorkFlow.com