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