Michigan Department of Treasury
151 (Rev. 02-16)
Issued under authority of Public Act 122 of 1941.
Authorized Representative Declaration (Power of Attorney)
INSTRUCTIONS: Use this form to authorize the Michigan Department of Treasury to communicate with a named individual or entity acting
on your behalf. Also use this form to designate a representative to receive copies of correspondence regarding a particular tax dispute
(other than City Income Tax). All information designated as “required” must be supplied for this authorization to be effective.
PART 1: TAXPAYER OR DEBTOR INFORMATION
Taxpayer’s Name and Address (Required)
If a business, include any DBA, trade or assumed name.
If filing joint return, include spouse’s name.
FEIN, ME or TR Number (Required for business taxes)
Taxpayer’s E-mail Address
Daytime Telephone Number (Required)
Taxpayer’s Social Security Number (Required if Spouse’s Social Security Number
no FEIN ME or TR Number listed)
PART 2: R