Wisconsin Tax Power of Attorney FormWisconsin Tax Power of Attorney Form
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Instructions
Wisconsin Department
of Revenue
Part 1

Taxpayer Name

Taxpayer Address (number and street)

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Power of Attorney

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Form

A-222

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Spouse Name

Social Security Number(s)

Wisconsin Tax Account Number

Spouse Address (if different from taxpayer)

Federal Identification Number

Telephone Number – Daytime

( )
City, State, and Zip Code

Part 2

City, State, and Zip Code

E-mail Address

Hereby appoint(s) the following individual(s) as attorney(s)-in-fact to represent the taxpayer(s) before the Department of
Revenue for the tax matter(s) specified in Part 3.
Name

Firm Name/Address

Telephone Number

**

( )
( )
( )

** Designated Receiver
Part 3

Type of Tax

Tax Year(s) or Period(s) Covered

Individual Income Tax. . . . . . . . . . . . . . . . . . .
Corporation Franchise or Income Tax . . . . . .
Excise Tax. . . . . . . . . . . . . .