Power of Attorney - Missouri Department of Revenue

The attorney(s)-in-fact (or either of them) are authorized, subject to revocation, to receive confidential information and perform
any and all acts that the taxpayer(s) can perform with respect to the above specified tax matters, but not the power to endorse or
receive checks in payment of any refunds.
Copies of notices and other written communications addressed to taxpayer(s) in proceedings involving the above tax matters
should be sent to:
1. the representative first named above; or
2. the following named representative(s) (no more than two):
By execution of this power of attorney, all earlier powers of attorney on file with the Department of Revenue, state of Missouri, for
the same tax matter(s) and years or periods covered by this power of attorney are revoked, except the following (specify to whom
power of attorney was granted, date and address, or refer to attached copies of earlier powers of attorney and authorizations.):
MO 860-1723 (10-2005)
DOR-2827 (10-2005)
MISSOURI DEPARTMENT OF REVENUE
POWER OF ATTORNEY
TAXPAYER’S NAME/BUSINESS NAME SOCIAL SECURITY NUMBER/FEDERAL I.D. NUMBER
SPOUSE’S NAME/BUSINESS NAME SPOUSE’S SSN/FEDERAL I.D. NUMBER
NUMBER AND STREET MITS I.D. NUMBER
CITY OR TOWN, STATE, ZIP CODE CHARTER NUMBER
TAXPAYER(S) HEREBY APPOINTS
PLEASE TYPE OR PRINT
NAME OF APPOINTED REPRESENTATIVE ADDRESS PHONE NUMBER
NAME OF APPOINTED REPRESENTATIVE ADDRESS PHONE NUMBER
NAME OF APPOINTED REPRESENTATIVE ADDRESS PHONE NUMBER
NAME OF APPOINTED REPRESENTATIVE ADDRESS PHONE NUMBER
as attorney(s)-in-fact to represent taxpayer(s) before the Department of Revenue, state of Missouri, with respect to the following
tax matter(s) (the tax type, form(s), and year(s) to which this form applies must be listed below):
TYPE OF TAX (INDIVIDUAL, SALES, CORPORATE
INCOME/FRANCHISE, WITHHOLDING, ETC.)
MISSOURI TAX FORM NUMBER
(MO-1040, MO-1120, ETC.)
YEAR(S) OR PERIOD(S)
(DATE OF DEATH IF ESTATE TAX)
Note: All appointed representatives
must
sign on reverse side of this form.
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