Wyoming Tax Power of Attorney FormWyoming Tax Power of Attorney Form
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State of Wyoming

DEPARTMENT OF REVENUE
DAVE FREUDENTHAL, Governor
EDMUND J. SCHMIDT, Director

122 West 25th Street, 2-West, Cheyenne, Wyoming 82002-0110
Telephone: (307) 777-7961 ż Web:http://revenue.state.wy.us ż E-mail:[email protected]

Administration Fax (307)777-7722 ż Ad Valorem Division Fax (307)777-7722 ż Excise Division Fax (307)777-3632 ż Mineral Division Fax (307)777-7849 ż Liquor Division Fax (307)777-6255

Excise Tax Division
Limited Power of Attorney
Sales/Use Tax License Number:
Revenue Identification Number:
Business’’/Owner’’s/Taxpayer’’s Name:
Mailing Address:

TO WHOM IT MAY CONCERN: I/We have appointed
as our agent to represent the above mentioned taxpayer before the Wyoming Excise Tax
Department for the following excise tax matters until further notice:
Tax Type (Sales, Use, Estate,
Cigarette, etc.)

Document Requested (Tax returns - specify
form #, written determinations, notices, etc.)

Year(s) or
Period(s)

I declare under penalty of perjury that I have the authority