BROOK PARK INCOME TAX

                               POWER OF ATTORNEY

                                    (6161 Engle Rd., Brook Park, Ohio  44142)

                                                  hereby grant Power of Attorney to
(PRINT OR TYPE TAXPAYERS NAME)

______________________________________________________________________________(
(PRINT OR TYPE PREPARERS NAME)
concerning my city income tax matters with the City of Brook Park, Ohio. This Power 
of Attorney will remain in effect until revoked by me, and it covers all pertinent tax 
information unless limited by the specific items listed below.
I wish to limit this Power of Attorney to the following income tax items:

The original of this form, along with original signatures, must be submitted to the tax office.

Taxpayer Signature                                            Taxpayer Account Number

Spouse Signature                                              Taxpayer Account Number

Preparer’s Signature                                          Phone

Preparer’s Mailing Address

THE State of Ohio                                             Tax Office Use

County of ____________________________}   ss:

Sworn to before me and signed in my presence at               _____________________________
                                                              Date Stamp:
________________________________________, Ohio

This _________Day of __________________, 20______             _____________________________
                                                              Received By
_____________________________________________
Notary Public                                                 _____________________________
                                                              Date Revoked: