Montana Department of Revenue Power of Attorney Form

Click Here to Download The Montana Dept. of revenue power of attorney form is mostly used by residents in order to have their accountant or someone else file taxes on their behalf.

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MONTANA
POA
Power of Attorney (POA) Rev 02 11
Authorization to Disclose Tax Information
Notice: Federal Form 2848 is acceptable if Section 3, Tax matters, identifi es “Montana” and the type of tax, tax form
number, and year(s) or period(s) that the representative is authorized to discuss with the Department of Revenue (DOR).
If completing this federal form, a copy is required to be provided to the DOR.
1. Taxpayer Information
Name of Taxpayer(s) SSN
Address FEIN
City State Zip Code
Telephone Number Fax Number E-mail Address
2. Authorization of Representative
Name of Representative Name of Firm (if applicable)
Address
City State Zip Code
Telephone Number Fax Number E-mail Address
3. Purpose of this Form
This form is used by taxpayers to either change a Power of Attorney status or provide written authorization to a
representative.
 Check this box if you are changing a current Power of Attorney status.
If you are providing authorization to another individual, check the box that best describes what authorization you are
providing to your representative.
 Representation. Department employees can provide confi dential tax information to the representative and discuss
the information. (This is the most frequent response.)
 Information sharing. Department employees can provide confi dential tax information to the representative, but
cannot discuss the information.
 Decision making authority. Department employees can provide confi dential information to a representative,
can discuss the information and the representative can act on the taxpayer’s behalf for all purposes, including
settlement and waiver of appeal rights.
4. Retention/Revocation of Prior Power(s) of Attorney
 Check this box if you are substituting one representative for another representative on fi le with the Montana
Department of Revenue for the same tax matters and year(s)/period(s) covered by this document. Checking this
box will revoke the authorization for the original representative.
0601
*06010101* Check this box if you do not want to revoke a prior authorization and are adding another representative. You must
attach a copy of any Authorization to Disclose Tax Information you want to remain in effect.
 Check this box if you want to revoke all prior authorizations made on your behalf.
If you are a representative and want to revoke an existing POA, simply write REVOKE across the top of the form, sign
the form in section 6 and fi le the form as indicated in section 7.
5. Tax Matters and Tax Years Covered by this Form
Your representative is authorized to inspect, receive and discuss confi dential information for the tax types and tax
years you authorize by checking the appropriate boxes below. If tax matters and tax periods are not specifi ed, this
written authorization will not be in effect.
Please specify Tax Years Please specify Tax Years
 Individual Income Tax _____________________  Withholding Tax _____________________
 Corporation License Tax _____________________  Lodging Facilities Tax _____________________
 Rental Vehicle Tax _____________________  Combined Oil and Gas Tax _____________________
 Other, please specify ____________________
6. Signature
If a tax matter concerns a joint return, both husband and wife must sign if they give decision making authority to
the representative. A signature by both is not required in any other circumstance. A signature by a corporate offi cer,
partner, guardian, executor, receiver, administrator, or trustee on behalf of the taxpayer, is a certifi cation by the
representative that they have the authority to execute the form on behalf of the taxpayer.
This Power of Attorney will not be honored if it is not signed and dated.
_________________________________________ ___________ __________________________________
Signature Date Title (if applicable)
_________________________________________
Print Name
_________________________________________ ___________ __________________________________
Signature of Spouse (if applicable) Date Title (if applicable)
_________________________________________
Print Name of Spouse
This authorization form takes effect upon receipt by the Montana Department of Revenue and remains in effect until
revoked. This authorization to disclose taxpayer information does not affect the routine mailing of tax forms, refund
checks, original notices or other original communications, which will continue to be sent only to the taxpayer.
7. Filing this Form
Mail or fax the completed form directly to the Montana Department of Revenue.
Montana Department of Revenue
Legal Services, Disclosure Offi ce
125 N. Roberts
PO Box 7701
Helena, MT 59604-7701
Fax (406) 444-4375. If you are already working with a department employee, please feel free to fax your completed
form directly to that person.
*06010201*
POA – page 2 SSN or FEIN Instructions for Power of Attorney (POA)
Authorization to Disclose Tax Information
Section 1. Taxpayer Information.
Individual. Enter the requested information in the boxes
provided. Do not use your representative’s address or
post offi ce box for your own. If a joint return is, or will be
fi led and you and your spouse are designating the same
representative(s), also enter your spouse’s information, if
different from yours.
Corporation, partnership, limited liability company or
association. Enter the name, FEIN, telephone number
and business address. If this form is being prepared
for corporations fi ling a combined tax return, a list of
subsidiaries is not required. This POA applies to all
members of the combined tax return.
Trust. Enter the name, title, telephone number and address
of the trustee, and the name and FEIN of the trust.
Estate. Enter the name, title, and address of the decedent’s
personal representative, and the name and identifi cation
number of the estate. The identifi cation number for an
estate includes both the FEIN, if the estate has one, and
the decedent’s SSN.
Section 2. Authorization of Representative.
Enter your representative’s full name. Only individuals
may be named as representatives. Use the identical full
name on all submissions and correspondence. Enter the
representative’s telephone number, address or post offi ce
box, and e-mail address, if applicable. A separate form
must be fi lled out for each designated representative,
unless two are named from the same fi rm or corporation.
Section 3. Purpose of this Form.
This form is used by taxpayers to either change a Power
of Attorney status or provide written authorization to a
representative. Check the fi rst box if you are changing
a current Power of Attorney status. If you are providing
authorization to another individual, check one of the next
three boxes, depending on what authorization you are
providing to your representative. A disclosure authorized
by this form may take place by telephone, letter, facsimile,
e-mail or a personal visit.
Note: Checking the “yes” box on the tax return answering
the question “May the DOR discuss this return with
the tax preparer shown?” authorizes Department of
Revenue employees to discuss the tax return itself
with the accountant/preparer. Any other issues, such
as outstanding tax liabilities, cannot be discussed
without a completed POA form.
Section 4. Retention/Revocation of Prior Power(s) of Attorney.
Check the box that best describes your intention,
including (1) substituting one representative for another
representative, (2) adding another representative or (3)
revoking all representatives.
If you are a representative and want to revoke an existing
POA, simply write REVOKE across the top of the form, sign
the form in section 6 and fi le the form as indicated in section 7.
Section 5. Tax Matters and Tax Years Covered by the Form.
Indicate, by checking the appropriate boxes, what tax types
and tax years you are authorizing your representative
to inspect, receive and discuss with the Department of
Revenue.
You may list any tax years or periods that have already
ended as of the date you sign the form. You may include
only future tax periods that end no later than three years
after the date the form is received by the Department of
Revenue. The three future periods are determined starting
after December 31 of the year the form is received by the
department. If the matter relates to estate tax, enter the
date of the decedent’s death.
If tax matters and tax periods aren’t specifi ed, the form will
not be in effect.
Section 6. Signature.
Individual. You must sign and date the form. The signature
of both spouses fi ling a joint return is required only if
they are giving decision making authority to the same
representative. Otherwise, either spouse may authorize
their own representative to receive and discuss their joint
tax return.
Corporation or association. An offi cer having authority to
bind the corporation must sign.
Partnership. All partners must sign unless one partner is
authorized to act in the name of the partnership. A partner
is authorized to act in the name of the partnership if, under
state law, the partner has authority to bind the partnership.
A copy of such authorization must be attached.
LLC. If the LLC is member managed, all members must
sign, unless one member is authorized to act in the name
of the LLC. A copy of such authorization must be attached.
If the LLC is manager managed, the manager must sign.
Estate, trust or other fi duciary. The personal representative
of an estate must sign. The trustee of a trust must sign. If a
guardian or conservator has been appointed for a taxpayer,
they must sign. In all cases, the fi duciary must include the
representative capacity in which they are signing, such as
“John Doe, guardian of Jane Roe.”
Section 7. Filing this Form.
Mail or fax the completed form directly to the Montana
Department of Revenue.
Montana Department of Revenue
Legal Services, Disclosure Offi ce
125 N. Roberts
PO Box 7701
Helena, MT 59604-7701
Fax (406) 444-4375. If you are already working with
a department employee, please feel free to fax your
completed form directly to that person.