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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)

Fax Number

PART 2: R