OES-190B (Rev.4-07) 
 
                     OKLAHOMA EMPLOYMENT SECURITY COMMISSION 
                             POWER OF ATTORNEY – BENEFITS 
                                                       
I, ___________________________________, am the owner or officer  with authority to contract for 
__________________________________________________________________________________________, 
Oklahoma Account #______________________________, Federal ID #________________________________. 
                                                       
I hereby appoint: 
 
 Name:                       ____________________________________ 
 Address:                    ____________________________________ 
 City, State, and Zip:       ____________________________________ 
 Telephone No.:              ____________________________________ 
 Fax No.:                    ____________________________________ 
 
As attorney-in-fact to represent the above-named taxpayer before the Oklahoma  Employment Security 
Commission with respect to all unemployment insurance benefit claims and issues arising pursuant to Article II of 
the Employment Security Act of 1980.  This Power of Attorney shall be effective immediately and shall remain in 
effect until the Oklahoma  Employment  Security Commission  receives notice  of its revocation.  A notice of a 
revocation of a Power of Attorney or a notice of change of address must be in a separate writing and mailed to the 
Oklahoma Employment Security Commission at P.O. Box 52003, Oklahoma City, OK  73152-2003.  The attorney-
in-fact is authorized to receive all confidential information pertaining to unemployment benefit claims relating to 
the above-named taxpayer.  This Power of Attorney removes all earlier Powers of Attorney previously granted by 
the taxpayer for unemployment benefit claim purposes. 
 
____________________________________                  ________________________________________
Date       Signature 
                                                      ________________________________________
       Printed Name 
                                                      ________________________________________
       Title 
 
                                     ACKNOWLEDGMENT 
 
State of __________________) 
     )   SS. 
County of ________________) 
 
 Before me, the undersigned, a notary public in and for this county and state, personally appeared 
___________________________ and acknowledged to me that he/she executed the above instrument in his/her 
official capacity as the free and voluntary act and deed of himself/herself and the taxpayer. 
 In witness of this  fact, I signed this  document  and  affixed my official seal on 
________________________________, ________. 
 
Official Seal with Commission Number 
And Expiration Date: 
                                                      _____________________________________________
                                                                 Notary Public
 
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