City of Westminster 
                                               Power of Attorney                              Department of Finance 
                                    For Department Administered Tax Matters                   Sales Tax Division 
                                               Please Type or Print Clearly
                           1) Legal Name of Business or Individual Name (Last, First):

                           2) Trade Name of Business (if any):

                           3) Mailing Address:                                                7) Phone Number:

                           4) City:                                        5) State:  6) Zip: 8) City Account Number:

9) Representatives: The above-named taxpayer hereby appoints the following representatives as attorney(s)-in-fact

A. Name(s) and address:                                                                       Phone Number:

                                                                                              Fax Number:

B. Name(s) and address:                                                                       Phone Number:

                                                                                              Fax Number:

10) Tax matters approved for representation:
                                                                                              Tax Periods:

                        Westminster Sales & Use Tax                                           __________ to __________
                                                                                              Tax Periods:

                        Westminster Admissions Tax                                            __________ to __________
                                                                                              Tax Periods:

                        Westminster Accommodations Tax                                        __________ to __________
                                                                                              Tax Periods:

                        Other Tax (Specify): ____________________________________             __________ to __________

11) Acts Authorized: The representatives named herein are authorized to receive and inspect confidential tax information and
to perform any an all acts that the above-named taxpayer can perform with respect to the tax matters described in number 10,
including, but not limited to, the authority to sign and bind the taxpayer to agreements, consents, or other documents. The
authority does not include the power to receive refund checks or the deleted acts specifically addressed below.

12) Added or Deleted Acts: List any specific additions or deletions to the acts otherwise authorized in this power of attorney.

THE TAXPAYER AND ALL REPRESENTATIVES MUST SIGN THE BACK OF THIS FORM

Power of Attorney for Department Administered Tax Matters                                                                       Page 2

13) Retention/Revocation of Prior Power(s) of Attorney: The filing of this power of attorney automatically revokes all earlier
power(s) of attorney filed with the Westminster Department of Finance by the above-named taxpayer for the same tax matters
and periods covered by this document. IF YOU DO NOT WANT TO REVOKE A PRIOR POWER OF ATTORNEY, you must
attach a copy of any power of attorney you want to remain in effect. You may revoke this power of attorney by writing REVOKE
along with the effective date at the top in clear and conspicuous print and returning a copy to the Department.

14) Signature of Taxpayer: If this form is not signed and dated, it is invalid. If this form is executed on behalf of the taxpayer by
a corporate officer, partner, guardian, tax matters partner, executor, receiver, estate administrator, trustee, or other agent or
employee, such person attests that he/she has the authority to execute this form on behalf of the taxpayer.

Taxpayer                  Signature                                                                         Date
Signature

                          Printed Name                             Title                                    Phone No.

15) Declaration & Signature of Representative(s):       I hereby declare that I am authorized to represent the above-named
taxpayer for the tax matter(s) and period(s) specified herein.

Representative            Signature                                                                         Date
Signature

                          Printed Name                             Title                                    Phone No.

I represent the above-named taxpayer as:

                          CPA Licensed In/Lic. No.:     ____________________________________

                          Attorney Licensed In/Lic. No.: ____________________________________

                          Other (explain): _____________________________________________________________________

Representative            Signature                                                                         Date
Signature

                          Printed Name                             Title                                    Phone No.

I represent the above-named taxpayer as:

                          CPA Licensed In/Lic. No.:     ____________________________________

                          Attorney Licensed In/Lic. No.: ____________________________________

                          Other (explain): _____________________________________________________________________

Return completed form to:  Westminster Department of Finance   Sales Tax Division   4800 W 92nd Avenue   Westminster,CO 80031
                           (303) 658-2065   Fax: (303) 706-3923  http://www.cityofwestminster.us