UC-424 (New 12/28/04) 
                                       STATE OF CONNECTICUT 
                                       DEPARTMENT OF LABOR 
       200 FOLLY BROOK BOULEVARD, WETHERSFIELD, CT 06109-1114 
                                                                                                   
                                       POWER OF ATTORNEY  
 
Know All Persons by These Presents That                                                                                             having its principal 
                                                                                                          (Client)                  
Office at                                                   does hereby appoint                                                                  to
                   (Place of Business)                                                                                     (Representative)       
represent the said company in unemployment tax and claim related matters before the: 
                                                                                                    
                                       Connecticut Department of Labor 
                                       200 Folly Brook Boulevard 
                                                  Wethersfield, CT 06109 
  
Until further notice. 
 
In Witness Whereof I have hereunto signed my name and said company has caused this instrument to be 
attested by the signature of its duly qualified officer this                                               day of                   ,          . 
                                                                                                    (Day)                  (Month)      (Year)  
This authorization cancels and supersedes all prior authorizations. 
 
By:           
Title:        
Employer registration number:         
Federal ID number:           
 
Dated this                     day of                                                                     ,              . 
Before me personally appeared                                                                                              , known to me and made  
oath to the truth of the matters contained herein. 
 
Notary Public                                                 
Commissioner of Superior Court                                
 
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