DR-835 Florida Department of Revenue R. 10/11 POWER OF ATTORNEY TC Rule 12-6.0015 and Declaration of Representative Florida Administrative Code Effective 01/12 See Instructions for additional information PART I - POWER OF ATTORNEY Section 1. Taxpayer Information. Taxpayer(s) must sign and date this form on Page 2, Part I, Section 8. Taxpayer name(s) and address(es) Federal ID no(s). (SSN*, FEIN, etc.) Florida Tax Registration Number(s) (Business Part. No., Sales Tax No., R.T. Acct No., etc.) Contact person Telephone number ( ) Fax number ( ) The Taxpayer(s) hereby appoint(s) the following representative(s) as attorney(s)-in-fact: Section 2. Representative(s). Each representative must be listed individually, and must sign and date this form on Page 2, Part II. Name and address (include name of firm if applicable) Telephone number ( ) Fax number ( ) E-mail address: Cell phone number ( ) Name and address (include name of firm if applicable) Telephone number ( ) Fax number ( ) E-mail address: Cell phone number ( ) Name and address (include name of firm if applicable) Telephone number ( ) Fax number ( ) E-mail address: Cell phone number ( ) To represent the taxpayer(s) before the Florida Department of Revenue in the following tax matters: Section 3. Tax Matters. Do not complete this section if completing Section 4. Type of Tax (Corporate, Sales, Reemployment, formerly Unemployment, etc.) Year(s) / Period(s) Tax Matter(s) (Tax Audits, Protests, Refunds, etc.) Section 4. To Appoint a Reemployment Tax (formerly Unemployment Tax) Agent Only. Do not complete Sections 3 and 6 if completing Section 4. By completing this section, an employer (taxpayer) appoints a representative to act as its Florida reemployment tax agent before the Florida Department of Revenue on a continuing basis and to receive confidential information with respect to mailings, filings, and other tax matters related to the Florida reemployment assistance program law. All other sections of this form (except Sections 3 and 6) must also be completed. Do not complete Section 4 unless you wish to appoint a reemployment tax agent on a continuing basis. Agent name Agent number (required) Firm name Federal I.D. No. (required) Address (if different from above) Telephone number ( ) Mail Type: See Instructions for explanations. Check one box only. ❑ 1 (Primary) ❑ 2 (Reporting) 3❑ (Rate) 4❑(Claim) Section 5. Acts Authorized. The representative(s) are authorized to receive and inspect confidential tax information and to perform any and all acts that I (we) can perform with respect to the tax matters described in Section 3 and Section 4 (for example, the authority to sign any agreements, consents, or other documents). Except as otherwise provided, the authority specifically includes the power to execute waivers of restrictions on assessment or collection of deficiencies in tax, to execute consents extending the statutory period for assessment or claims for refund of taxes, and to execute closing agreements under section 213.21, Florida Statutes. This authority does not include the power to endorse or cash warrants, or the power to sign certain returns. If you want to authorize a representative named in Section 2 to receive (but not to endorse or cash) refund warrants, write the name of the representative on this line and check the box ........................u ___________________________________________________________________________ ❑ List any specific limitations or deletions to the acts otherwise authorized in this Power of Attorney. ______________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________ |
DR-835 R. 10/11 Page 2 Florida Tax Registration Number: Taxpayer Name(s): Federal Identification Number: • Taxpayer(s) must complete Page 1 of this Power of Attorney or it will not be processed. Section 6. Notices and Communication. Do not complete Section 6 if completing Section 4. • Notices and other written communications will be sent to the first representative listed in Part I, Section 2, unless the taxpayer selects one of the options below. Receipt by either the representative or the taxpayer will be considered receipt by both. a. If you want notices and communications sent to both you and your representative, check this box ............................... u ❑ b. If you want notices or communications sent to you and not your representative, check this box .................................... u ❑ Certain computer-generated notices and other written communications cannot be issued in duplicate due to current system constraints. Therefore, we will send these communications to only the taxpayer at his or her tax registration address. Section 7. Retention / Nonrevocation of Prior Power(s) of Attorney. The filing of this Power of Attorney will not revoke earlier Power(s) of Attorney on file with the Florida Department of Revenue, even for the same tax matters and years or periods covered by this document. If you want to revoke a prior Power of Attorney, check this box ............................................................................................................................................. u ❑ You must attach a copy of any Power of Attorney you wish to revoke. Section 8. Signature of Taxpayer(s). If a tax matter concerns a joint return, both husband and wife must sign if joint representation is requested. If signed by a corporate officer, partner, member/managing member, guardian, tax matters partner/person, executor, receiver, administrator, trustee, or fiduciary on behalf of the taxpayer, I declare under penalties of perjury that I have the authority to execute this form on behalf of the taxpayer. Under penalties of perjury, I (we) declare that I (we) have read the foregoing document, and the facts stated in it are true. If this Power of Attorney is not signed and dated, it will be returned. _______________________________________________________________________________________ ________________________________________ _________________________________________ Signature Date Title (if applicable) _______________________________________________________________________________________ Print name _______________________________________________________________________________________ ________________________________________ _________________________________________ Signature Date Title (if applicable) _______________________________________________________________________________________ Print name PART II - DECLARATION OF REPRESENTATIVE Under penalties of perjury, I declare that: • I am familiar with the mandatory standards of conduct governing representation before the Department of Revenue, including Rules 12-6.006 and 28-106.107 of the Florida Administrative Code, as amended. • I am familiar with the law and facts related to this matter and am qualified to represent the taxpayer(s) in this matter. • I am authorized to represent the taxpayer(s) identified in Part I for the tax matter(s) specified therein, and to receive and inspect confidential taxpayer information. • I am one of the following: a. Attorney - a member in good standing of the bar of the highest court of the jurisdiction shown below. b. Certified Public Accountant - duly qualified to practice as a certified public accountant in the jurisdiction shown below. c. Enrolled Agent – enrolled as an agent pursuant to the requirements of Treasury Department Circular Number 230. d. Former Department of Revenue Employee. As a representative, I cannot accept representation in a matter upon which I had direct involvement while I was a public employee. e. Reemployment Tax Agent authorized in Section 4 of this form. f. Other Qualified Representative • I have read the foregoing Declaration of Representative and the facts stated in it are true. If this Declaration of Representative is not signed and dated, it will not be processed. Designation – Insert Jurisdiction (State) and Signature Date Letter from Above (a -f) Enrollment Card No. (if any) |
DR-835 R. 10/11 Page 3 POWER OF ATTORNEY INSTRUCTIONS Purpose of this form Section 2 – Representative(s) A Power of Attorney (Form DR-835) signed by the taxpayer and the Enter the individual name, firm name (if applicable), address, representative is required by the Florida Department of Revenue telephone number(s), and fax number of each individual appointed as in order for the taxpayer’s representative to perform certain acts attorney-in-fact and representative. If the representatives have the on behalf of the taxpayer and to receive and inspect confidential same address, simply write “same” in the appropriate box. If you wish tax information. You and your representative must complete, sign, to appoint more than three representatives, you should attach a letter and return Form DR-835 if you want to grant Power of Attorney to Form DR-835 listing those additional individuals. to an attorney, certified public accountant, enrolled agent, former Section 3 – Tax Matters Department employee, reemployment tax agent, or any other qualified Enter the type(s) of tax this Power of Attorney authorization applies to individual. A Power of Attorney is a legal document authorizing and the years or periods for which the Power of Attorney is granted. someone other than yourself to act as your representative. The word “All” is not specific enough. If your tax situation does not fit You may use this form for any matters affecting any tax administered into a tax type or period (for example, a specific administrative appeal, by the Department of Revenue. This includes both the audit and audit, or collection matter), describe it in the blank space provided collection processes. A Power of Attorney will remain in effect until for “Tax Matters.” The Power of Attorney can be limited to specific you revoke it. If you provide more than one Power of Attorney with reporting period(s) that can be stated in year(s), quarter(s), month(s), respect to a tax and tax period, the Department employee handling etc., or can be granted for an indefinite period. You must indicate your case will address notices and correspondence relative to that the tax types, periods, and/or matters for which you are authorizing issue to the first person listed on the latest Power of Attorney. representation by your attorney-in-fact. A Power of Attorney Form is generally not required, if the Examples: representative is, or is accompanied by: a trustee, a receiver, an Sales and Use Tax First and second quarter 2008 administrator, an executor of an estate, a corporate officer, or an Corporate Income Tax 7/1/07 – 6/30/08 authorized employee of the taxpayer. Communications Services Tax 2006 thru 2008 Photocopies and fax copies of Form DR-835 are usually acceptable. Insurance Premium Tax 1/1/06 – 12/31/08 E-mail transmissions or other types of Powers of Attorney are not Technical Assistance Advisement Request dated 8/6/08 acceptable. Copies of Form DR-835 are readily available by visiting Claim for Refund 3/7/07 our Internet site (www.floridarevenue.com/forms). Section 4 – To Appoint a Reemployment Tax Agent How to Complete Form DR-835, Power of Attorney Complete this section only if you wish to appoint an agent for PART I POWER OF ATTORNEY reemployment taxes on a continuing basis. You should not complete Section 1 – Taxpayer Information Section 3 or Section 6, but you must complete the remaining sections • For individuals and sole proprietorships: Enter your name, of Form DR-835. address, social security number, and telephone number(s) in the Enter the agent’s name. It must be the same name as found in spaces provided. Enter your federal employer identification number Section 2. Enter the firm name and address. You do not need to (FEIN), if you have one. If a joint return is involved, and you and complete the address line if you reported that information in Section 2. your spouse are designating the same attorney(s)-in-fact, also enter 1. Enter the agent number. The agent number is a seven-digit your spouse’s name and social security number, and your spouse’s number assigned by the Department of Revenue. address if different from yours. 2. Enter the federal employer identification number. The FEIN is a • For a corporation, limited liability company, or partnership: nine-digit number assigned to the agent by the Internal Revenue Enter the name, business address, FEIN, a contact person familiar Service. with this matter, and telephone number(s). 3. Select the mail type. • For a trust: Enter the name, title, address, and telephone number(s) of the fiduciary, and name and FEIN of the trust. Primary Mail. If you select primary mail, the agent will receive all documents from the Department of Revenue related to this • For an estate: Enter the name, title, address, and telephone reemployment tax account, and will be authorized to receive number(s) of the decedent’s personal representative, and the name confidential information and discuss matters related to the tax and and identification number of the estate. The identification number wage report, benefit information, claims, and the employer’s rate. for an estate includes both the FEIN if the estate has one and the decedent’s social security number. Reporting Mail. If you select reporting mail, the agent will receive the Employer’s Quarterly Report (Form RT-6), certification, and • For any other entity: Enter the name, business address, FEIN, correspondence related to reporting. The agent will be authorized to and telephone number(s), as well as the name of a contact person receive confidential information and discuss the tax and wage report, familiar with this matter. certification, and correspondence with the Department. • Identification Number: The Department may have assigned you Rate Mail. If you select rate mail, the agent will receive tax rate a Florida tax registration number such as a sales tax number, a notices and correspondence related to the rate and will be authorized reemployment tax account number, or a business partner number. to receive confidential information and discuss the employer’s rate These numbers further assist the Department in identifying your notices and rate with the Department. particular tax matter, and you should enter them in the appropriate box. If you do not provide this information, the Department may not Claims Mail. If you select claims mail, the agent will receive the be able to process the Power of Attorney. notice of benefits paid, and will be authorized to receive confidential information and discuss matters related to benefits. Note: Duplicate copies of certain computer-generated notices and other written communications cannot be issued due to current system constraints and therefore, these communications will be sent only to the representative. |
DR-835 R. 10/11 Page 4 Note: If you wish to appoint a representative to act on your behalf in governing representation before the Department of Revenue. The a specific and non-continuing reemployment tax matter, you should representative(s) must also declare, under penalties of perjury, that he complete Section 3 and Section 6 and not Section 4. For example, or she has been authorized to represent the taxpayer(s) in this matter if you hire a representative to assist you with a single matter, such as and authorized by the taxpayer(s) to receive confidential taxpayer a reemployment tax audit or contesting the payment of a claim, and information. wish that representative to handle just that one matter, you should The representative(s) you name must sign and date this declaration not complete Section 4 to authorize that representation. Instead, you and enter the designation (i.e., items a-f) under which he or she is should fill out Section 3 and specify the exact matter the representative authorized to represent you before the Department of Revenue. is handling. a. Attorney – Enter the two-letter abbreviation for the state (for Section 5 – Acts Authorized example “FL” for Florida) in which admitted to practice, along with Your signature on the back of the Power of Attorney authorizes the your bar number. individual(s) you designate (your representative or “attorney-in-fact”) to perform any act you can perform with respect to your tax matters, b. Certified Public Accountant – Enter the two-letter abbreviation except that your representative may not sign certain returns for you for the state (for example “FL” for Florida) in which licensed to nor may your representative negotiate or cash your refund warrant. practice. This authority includes signing consents to a change in tax liability, c. Enrolled Agent – Enter the enrollment card number issued by the consents to extend the time for assessing or collecting tax, closing Internal Revenue Service. agreements, and compromises. You may authorize your representative to receive, but not negotiate or cash, your refund warrant by checking d. Former Department of Revenue Employee – Former employees the box in Section 5 and writing the name of the representative on the may not accept representation in matters in which they were line below. If you wish to limit the authority of your representative other directly involved, and in certain cases, on any matter for a period than in the manner previously described, you must describe those of two years following termination of employment. If a former limits on the lines provided in Section 5. Department of Revenue employee is also an attorney or CPA, then the additional designation, jurisdiction, and enrollment card Section 6 – Mailing of Notices and Communications should also be entered. If you do not check a box, the Department will send notices and other written communications to the first representative listed in Section 2, e. Reemployment Tax Agent – A person(s) appointed under unless you select another option. If you wish to have no documents Section 4 of the Power of Attorney to handle reemployment tax sent to your representative, or documents sent to both you and your matters on a continuing basis. A separate Power of Attorney representative, you should check the appropriate box in Section 6. form must be completed in order for a reemployment tax agent to Check the second box if you wish to have notices and other written handle a specific and non-continuing matter such as a protest of a communications sent to you and not to your representative. In reemployment tax rate. certain instances, the Department can only send documents to the f. Other Qualified Representative – An individual may represent taxpayer. Therefore, the taxpayer has the responsibility of keeping the a taxpayer before the Department of Revenue if training and representative informed of tax matters. experience qualifies that person to handle a specific matter. Note: Taxpayers completing Section 4 (To Appoint a Reemployment Rule 28-106.107, Florida Administrative Code, sets out mandatory Tax Agent Only) should not complete Section 6. See Section 4 of these standards of conduct for all qualified representatives. A representative instructions for information regarding notices and communications sent shall not: to a reemployment tax agent. (a) Engage in conduct involving dishonesty, fraud, deceit, or Section 7 – Retention/Nonrevocation of Prior Power(s) of Attorney misrepresentation. The most recent Power of Attorney will take precedence over, but will (b) Engage in conduct that is prejudicial to the administration of not revoke, prior Powers of Attorney. If you wish to revoke a prior justice. Power of Attorney, you must check the box on the form and attach a copy of the old Power of Attorney. (c) Handle a matter that the representative knows or should know that he or she is not competent to handle. Section 8 – Signature of Taxpayer(s) The Power of Attorney is not valid until signed and dated by the (d) Handle a legal or factual matter without adequate preparation. taxpayer. The individual signing the Power of Attorney is representing, *Social security numbers (SSNs) are used by the Florida under penalties of perjury, that he or she is the taxpayer or authorized Department of Revenue as unique identifiers for the administration of to execute the Power of Attorney on behalf of the taxpayer. Florida’s taxes. SSNs obtained for tax administration purposes are • For a corporation, trust, estate, or any other entity: A corporate confidential under sections 213.053 and 119.071, Florida Statutes, officer or person having authority to bind the entity must sign. and not subject to disclosure as public records. Collection of your SSN is authorized under state and federal law. Visit our Internet • For partnerships: All partners must sign unless one partner is site at www.floridarevenue.com and select “Privacy Notice” for authorized to act in the name of the partnership. more information regarding the state and federal law governing the • For a sole proprietorship: The owner of the sole proprietorship collection, use, or release of SSNs, including authorized exceptions. must sign. Where to Mail Form DR-835 • For a joint return: Both husband and wife must sign if the If Form DR-835 is for a specific matter, mail or fax it to the office or representative represents both. If the representative only employee handling the specific matter. You may send it with the represents one spouse, then only that spouse should sign. document to which it relates. PART II – DECLARATION OF REPRESENTATIVE If Form DR-835 is for a reemployment tax matter and the taxpayer has Any party who appears before the Department of Revenue has the completed Section 4, mail it to the Florida Department of Revenue, right, at his or her own expense, to be represented by counsel or by a P.O. Box 6510, Tallahassee FL 32314-6510, or fax it to 850-488-5997. qualified representative. The representative(s) you name must declare, under penalties of perjury, that he or she is qualified to represent you in this matter and will comply with the mandatory standards of conduct |