Findlay Income Tax Department 
                                           Post Office Box 862, Findlay, Ohio 45839-0862 
                                           PH:  419-424-7133      •                                                         FX:  419-424-7410 
                                                incometax@findlayohio.com 
 
                          Taxpayer's Declaration and Authorization of Representation 
 
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Taxpayer's Legal Name 
 
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Trade Name or Doing business as… 
 
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Address 
 
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City, State, and Zip Code 
 
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Phone Numbers                                                                                                           Fax number                                                     e-mail address 
 
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Social Security Number and/or Federal Employer Identification Number 
 
I hereby authorize the accountant, attorney, agent, enrolled agent, or other person listed below to represent me during any 
audit, investigation, discussion, hearing, court hearing, or any other proceedings conducted by, for, with, or through the 
Income Tax Department of the City of Findlay and to represent me before Findlay's Local Board of Tax Review.  To facilitate 
these matters, I authorize the Findlay Income Tax Department to furnish, provide, or issue any and all necessary, relevant, 
and pertinent records, returns, reconciliations, filings, and notifications of current, prior, timely, delinquent, or past-due filings, 
forms, and/or taxes to the representative listed below without limitations or restrictions except for those delineated in the 
“Restrictions” section below. 
 
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Taxpayer's Signature                                                                                                   Date 
 
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Representative’s Name                                                                                              Representative’s Firm/Company/Law Office/Organization 
 
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Representative’s Address 
 
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Representative’s City, State, and Zip Code 
 
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Representative’s Phone Numbers                                                                               Fax number                                                    e-mail address 
 
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Representative's Signature                                                                                         Date 
 
Restrictions: _________________________________________________________________________________ 
 
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                                                                                                                                                                                                      Authorization  of Representation 6/30/2020