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Power of Attorney Declaration
To send a Power of Attorney Declaration (POA) online, use e-Services for Business (eddservices.edd.ca.gov/tap/secure/eservices).
I. Employer and Taxpayer Information
California Employer Payroll Tax Account Number: (if applicable) Federal Employer Identification Number:
Owner (Limited Liability Company, Limited Partnership, Corporation Name) Corporate (Limited Liability Company, Limited Partnership Identification Number)
Business Name (Or Doing Business As):
Business Mailing Address: City: State: ZIP Code:
Business Phone Number: Business Fax Number:
Business Location (if different from above): City: State: ZIP Code:
II. Representative Designation
I hereby appoint the following person to represent the employer or taxpayer for specified matters arising under the
California Unemployment Insurance Code.
Representative Business:
Representative Name: Phone Number: Fax Number:
Business Mailing Address: City: State: ZIP Code:
III. Authorized Act
All Authorization: To represent the employer or taxpayer and receive mailings for all state tax matters.
Specific Declaration: The representative will have limited authority to your state tax matters.
Indicate the specific dates and acts you are authorizing from ____________ To ____________
To represent the employer or taxpayer for any or all:
Tax reporting Benefit reporting Both matters relating to the reporting period indicated above
To represent the employer or taxpayer and receive mailings for any and all
Tax reporting Benefit reporting Both matters relating to the reporting period indicated above
Other acts: __________________________________________________________
IV. Signature Authorizing Power of Attorney
Signature of the employer or taxpayer, owner, managing member, officer, receiver, administrator, or trustee for the
employer or taxpayer: If you are a corporate officer, partner, guardian, tax matter person, executor, receiver, administrator, or
trustee on behalf of the employer or taxpayer, you are certifying that you have the authority to execute this form on behalf of
the employer or taxpayer by signing this Power of Attorney Declaration.
If this Power of Attorney Declaration is not signed and dated, it will be returned as invalid.
I certify under penalty of perjury that the above information is true, correct, and complete, and that these actions are not to
be taken to receive a more favorable Unemployment Insurance rate. I further certify that I have the authority to sign on behalf
of the above business.
____________________________________ ________________________________________________________
Signature Title
______________________________ ________________________
Print Name Date
DE 48 Rev. 12 (4-23) (INTERNET) Page 2 of 2
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