Parish of Rapides 
                                        Sales & Use Tax Department 
                                        5606 Coliseum Blvd, Alexandria, LA  71303 
                                        (318) 445-0296 Phone  (318) 449-4532 Fax 
                                        info@rpst.org Email  www.laota.com Web  
                                                             
                                        POWER OF ATTORNEY 
(Please Print) 
                                                                        
                                                                                               t # 
 
                                                                                          /  
 
                                                             Mark one: 
Street Address                                                Original – Your first power of attorney authorizing 
                                                             this agent and attorney-in-fact 

City/State/Zip                                                Amend – Changes an existing power of attorney for 
                                                                   
Expiration Date                                       
                       Month/Day/Year                         Cancel/Revoke – Cancels a previously filed power of 
                                                                           
I/we hereby make, name, constitute and appoint  
                                                                    gent and attorney-in-fact 
 
                                                                   one/Fax/Email 
 
my/our true and lawful agent and attorney-in-fact for me/us and in my/our name, place, and stead to receive and inspect 
confidential tax information and to perform any and all acts, including signing a tax return, that this taxpayer can perform 
with respect to the taxes and taxable year(s) or period(s) set forth below.  The authorizations granted above apply to the 
following taxes/licenses/permits/fees:  
 
(Check all that apply) 
   Sales and Use Taxes (Rapides Parish Police Jury, Rapides Parish School Board, Rapides Parish Law Enforcement 
 District, Rapides Parish Sales Tax District # 3, City of Alexandria, City of Pineville, Town of Glenmora, Town of 
 Lecompte, Town of Ball, Town of Boyce, Town of Woodworth, Village of Forest Hill and Town of Cheneyville) 
 
   Hotel/Motel  Occupancy  Taxes  (Alexandria/Pineville  Convention  and  Visitors  Bureau  and  Greater  Alexandria 
 Economic Development Authority) 
 
   Occupational License Taxes (Rapides Parish Police Jury, City of Alexandria, City of Pineville, Town of Glenmora, 
 Town of Lecompte, Town of Ball, Town of Boyce, Town of Woodworth and Village of Forest Hill) 
 
   Insurance Premium Taxes (Rapides Parish Police Jury, City of Alexandria and Town of Forest Hill) 
 
   Alcohol Beverage Permit Fees (Rapides Parish Police Jury, City of Alexandria, City of Pineville, Town of Glenmora, 
 Town of Lecompte, Town of Boyce and Town of Woodworth) 
 
   Chain Store Permit Fees (Rapides Parish Police Jury, City of Alexandria, City of Pineville, Town of Glenmora, Town of 
 Ball, Town of Boyce and Town of Woodworth) 
 
   Charitable Gaming License Fees (Rapides Parish Police Jury, City of Alexandria, City of Pineville, Town of Glenmora, 
 Town of Lecompte, Town of Ball, Town of Boyce and Town of Woodworth) 
 

The agent and attorney-in-fact shall be authorized to receive copies of notices and communications from the Rapides 
Parish  Sales  and  Use  Tax  Department  upon  request.    The  taxpayer  will receive  the original  notices  and  written 
communications.  The authority does not include the power to receive and to sign refund checks or the power to substitute 
another representative unless specifically added below.   
 
List any specific additions or deletions to the acts otherwise authorized in this power of attorney. 
 
(Note:  Without express permission, the Rapides Parish Sales Tax Department will not issue refunds to anyone 
but to the remitter or another government entity.) 

The filing of this Power of Attorney with the Rapides Parish Sales and Use Tax Department revokes all earlier Power(s) of 
Attorney on file for the same taxes and taxable year(s) or period(s) covered by this document. 
 
By signing this Power of Attorney as a corporate officer, partner, guardian, tax matters partner, executor, receiver, 
administrator, or trustee on behalf of the taxpayer, I certify that I have the authority to execute this form on behalf of the 
taxpayer.   
 
Under penalties of perjury, I declare that: 
  I am not currently under suspension or disbarment from practice before the Internal Revenue Service. 
  I am one of the following: 
 
   Attorney – a member in good standing of the highest court where authorized to practice law.                               
                                                                                                           
   Certified Public Accountant – duly qualified to practice as a certified public accountant in the state where 
   authorized to practice public accounting.                      
                                                          
   Enrolled Agent – a person enrolled to practice before the Internal Revenue Service.  
                                                                                                            License # 
 
   Officer/Partner/Member/Manager – a bona fide representative of the taxpayer corporation, partnership, LLC, LLP, 
   or other legal entity). 
 
   Employee – an employee of the taxpayer. 
 
   Family Member – a member of the taxpayer’s immediate family (state relationship, i.e., spouse, parent, child, 
                
   Other (state the relationship, i.e., bookkeeper, friend, etc.)
 
Thus sworn to and subscribed before me, Notary, in the presence of the undersigned two witnesses, who 
                                                                                                       
Taxpayer’s Signature                                       gnature of duly authorized representative                  Title 
                                                                                     .) 

Signature of Witness                                                                                                    
 
Signature of Witnesses