Tennessee Tax Power of Attorney FormTennessee Tax Power of Attorney Form
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TENNESSEE DEPARTMENT OF REVENUE
POWER OF ATTORNEY
PART 1

Power of Attorney (Please type or print.)

1. Taxpayer Information (Taxpayer must sign and date this form on line 6.)
Account number(s)

Taxpayer name and address

Daytime telephone number
(

)

hereby appoints the following representative as attorney-in-fact:

2. Representative (Representative must sign and date this form on page 2, Part II.)
Name and address
Telephone No. (
Fax No. (

)

)

to represent the taxpayer before the Tennessee Department of Revenue for the following tax matters:
3. Tax Matters
Year(s) or Period(s)

Type of Tax (Sales and Use, Franchise, Excise, etc.)

4. Acts Authorized. --The representative is authorized to receive and inspect confidential tax information and to perform any and
all acts that I can perform with respect to the tax matters described in line 3, for example, the authority to sign any agreements,
consents, or other documents. The authority does not include the power to receive refund chec