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I-1040POA CITY OF IONIA INCOME TAX DEPARTMENT
Power of Attorney Authorization
Issued under Authority of the Uniform City Income Tax Ordinance (MCL 141.601 et seq.) Filing is voluntary.
Complete this form if you wish to appoint someone to represent you to the Income Tax Department on income tax matters, or if you wish to revoke or change
your current power of attorney authorization. Read the instructions on page 2 before completing this form.
PART 1: TAXPAYER INFORMATION
Taxpayer's (first name, initial, last name or business name) Taxpayer SSN/FEIN
If joint return spouse's first name, initial, last name Spouse SSN
Current address (number and street) Apt./Ste. no. If a business, enter DBA, trade or assumed name
Address line 2 Telephone number Fax number
City, town or post office State Zip code E-mail address
Foreign country name, province/county, postal code
PART 2: REPRESENTATIVE INFORMATION AND AUTHORIZATION DATES
Representative's name Contact's name (if applicable) Contact's name (if applicable)
Firm name E-mail address E-mail address
Address (number and street) Apt./Ste. no. Telephone number Telephone number
Address line 2 Fax number Fax number
City, town or post office State Zip code Beginning authorization date (MM/DD/YY) Ending authorization date (MM/DD/YY)*
Foreign country name, province/county, postal code
PART 3: TYPE OF AUTHORIZATION
GENERAL AUTHORIZATION
Authorizes my representative to: (1) inspect or receive confidential information; (2) represent me and make oral or written presentations of fact and
argument; (3) sign returns; (4) enter into agreements; (5) receive mail including forms, billings and payment notices. This authorization applies to all
tax matters for all tax years or periods.
LIMITED AUTHORIZATION All Tax Only as
Select the type of authorization by checking the appropriate boxes. Matters Specified
Below
1. Inspect or receive confidential information
2. Represent me and make oral or written presentations of fact and argument
3. Sign returns
4. Enter into agreements
5. Receive mail (includes forms, billings and payment notices)
Type of Income Tax Tax Form or Assessment Number Tax Year(s) or Period(s)
PART 4: CHANGE IN POWER OF ATTORNEY REPRESENTATION OR REVOCATION
CHANGE IN POWER OF ATTORNEY REPRESENTATION: This form replaces all earlier powers of attorney, except those attached, on file for the same tax matters
and years or periods covered by this Power of Attorney.
REVOKE PREVIOUS AUTHORIZATION: I revoke all Powers of Attorney submitted and will represent myself in all tax matters. Attach copies of all Powers of
Attorney that remain in effect concurrent with this new authorization.
PART 5: TAXPAYER SIGNATURE(S)
If signed by a corporate officer, partner or fiduciary on behalf of the taxpayer, I certify that I have the authority to execute this Power of Attorney.
Signature Name or title typed or printed Date
Spouse's signature Name or title typed or printed Date
* If no Ending Authorization date is provided, the above-named representative will be authorized to represent you until you notify the Income Tax Department
in writing that this Power of Attorney is revoked.
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