Parish of Rapides 
                                         Sales & Use Tax Department 
                                         P.O. Box 671, Alexandria, LA  71309 
                                        (318) 445-0296 Phone  (318) 449-4532 Fax 
                                        info@rpst.org Email  www.laota.com Web  
                                                             
                                         POWER OF ATTORNEY 
(Please Print) 
State of                                                     Parish/County of                                    
 
Your Name                                                    Social Security or EIN & Parish Taxpayer Account # 
 
                                                                                          /                      
 
Name of Business                                             Your Title 
 
                                                             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 
                                                             (name)                                              
Expiration Date                                       
                        Month/Day/Year                         Cancel/Revoke – Cancels a previously filed power of 
                                                             attorney for (name)                                 
 
I/we hereby make, name, constitute and appoint                                                                   
                                                                   Agent and attorney-in-fact 
 
Mailing Address                         City/State/Zip             Telephone/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 and Village of Forest Hill) 
 
  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 and Town of Woodworth) 
 
  Insurance Premium Taxes (Rapides Parish Police Jury and City of Alexandria) 
 
  Alcohol Beverage Permit Fees (Rapides Parish Police Jury, City of Alexandria, 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) 
 
for the taxable year(s) or period(s)                                                                             
 

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.                               
                                                                                                           Bar # 
 
   Certified  Public  Accountant  –  duly  qualified  to  practice  as  a  certified  public  accountant  in  the  state  where 
   authorized to practice public accounting.                         
                                                   License # 
 
   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, 
   brother or sister).                                                                                                       
 
   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 
personally came and appeared, on this               day of                                           , 20             . 
 
Taxpayer’s Signature                                      Signature of duly authorized representative                 Title 
(Sole Proprietor)                                         (Corporation, Partnership, LLC, LLP, etc.) 
             
Signature of Witness                                      Notary Public                                               ID # 
 
Signature of Witnesses 
 
                                                                          (Seal)