Power of Attorney 
                                Sales and Use Tax Division 

1. Taxpayer information and identification.  Taxpayers must sign on reverse side.
Taxpayer Name(s) and address (include any trade name or DBA). Daytime Phone Number 
                                                              (         ) 

                                                              Email Address 

                                                              City of Centennial Sales Tax License 

                                                              Colorado Dept of Revenue Sales Tax No. 

                                                              Social Security Number for Individual 

2. Representative(s).  Representative(s) must sign on the reverse side.
   Hereby appoint(s) the following representative(s) as attorney(s)-in-fact
   A. Name(s) and address                                     Phone Number 
                                                              (         ) 
                                                              Fax Number 
                                                              (     ) 
                                                              Email Address 

                                                              Attorney Registration Number or FEIN 

   B. Name(s) address                                         Phone Number 
                                                              (         ) 

                                                              Fax Number 
                                                              (        ) 
                                                              Email Address 

                                                              Attorney Registration Number or FEIN 

3. Tax matters approved for representation:

  City of Centennial Sales Tax                               Period From __________ to ___________ 
  City of Centennial Building Materials Used Tax and/or      Identification Number (permit or VIN) 
Motor Vehicle Use Tax
4. Acts Authorized – The representatives are authorized to receive and inspect confidential tax information
   and records and to perform any and all acts that the taxpayer named above can perform with respect to
   the tax matters described in #3, for example, the authority to sign and bind the taxpayer above to
   agreements, consents, or other documents.  The authority does not include the power to receive refund
   checks or the deleted acts specifically addressed in #5.

      13133 East Arapahoe Road    Centennial, Colorado 80112    303.325.8000     www.centennialco.gov   

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

6. Retention/Revocation of Prior Power(s) of Attorney – The filing of this power of attorney automatically
  revokes all earlier power(s) of attorney on file with the City of Centennial for the same tax matters and
  periods covered by this document.  If you do not want to revoke a prior power of attorney, check here  
  YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT.
7. Signature of Taxpayer(s) – If this form is not signed, dated and titled (if applicable), it is invalid.  If tax
  matters concern a joint return, both parties must sign for joint representation.  If signed by a corporate
  officer, partner, guardian, tax matters partner, executor, receiver, estate administrator or trustee on
  behalf of the taxpayer, I certify that I have the authority to execute this form on behalf of the taxpayer.
Signature                                           Date 

Print Name                                          Title 

Signature                                           Date 

Print Name                                          Title 

8. Declaration of Representative – I am authorized to represent the taxpayer(s) identified in #1 for the tax
  matter specified.
Signature/Date                                      Title 

I represent the taxpayer(s) identified in #1, as: 

 CO attorney, Registration #_________________     Attorney registered in _________________

 CO licensed CPA                                  CPA licensed in _____________________

 full time employee of the Taxpayer               Enrolled Agent ______________________

 Other, explain________________________________________________________________________

Signature/Date                                      Title 

I represent the taxpayer(s) identified in #1, as: 

 CO attorney, Registration #_________________     Attorney registered in _________________

 CO licensed CPA                                  CPA licensed in _____________________

 full time employee of the Taxpayer               Enrolled Agent ______________________

 Other, explain________________________________________________________________________

Signature/Date                                      Title 

  Power of Attorney                                 Page  2of  2