Utah Tax Power of Attorney Form
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Utah State Tax Commission

Power of Attorney and Declaration of Representative
Taxpayer name(s) and addresses

Clear form

Social Security/Account number

The taxpayer(s) named above hereby appoint the following representative(s) as attorney(s)-in-fact
(attach additional sheets if necessary)
Telephone number

Name and address

Fax number
Telephone number

Name and address

Fax number
Name and address

Telephone number
Fax number

Tax matters to be represented for the taxpayer(s) before the Utah State Tax Commission
Type of tax

Social Security/Account number

Year or period

Appeal number if known

Type of tax

Social Security/Account number

Year or period

Appeal number if known

Type of tax

Social Security/Account number

Year or period

Appeal number if known

Subject to revocation in writing, my representative is authorized to receive, inspect or review confidential tax information and to
perform any and all acts on my behalf to facilitate audits, to negotiate or enter agreements