Date of 
                                                    State of Arkansas                                                    Revocation  
                                       Department of Finance and Administration                                           
                                                    Power of Attorney                                                    __________ 
                                                                            
1 Taxpayer Information 
Taxpayer name(s) and address (Please type or print) Social Security Number(s)                      Employer Identification 
                                                                                                   Number 
                                                    Primary                                         
                                                     
                                                    Spouse                       
                                                     
                                                    Sales tax permit number                        Daytime Telephone Number 
                                                                                                         
hereby appoint(s) the following representative(s) as attorney(s)-in-fact: 
 
2 Representative(s) 
Name and address (Please type or print)                                   Telephone Number        
                                                                           
                                                                          Fax Number         
                                                                           
Name and address                                                          Telephone Number         
                                                                           
                                                                          Fax Number         
                                                                           
to represent the taxpayer(s) before the Arkansas Department of Finance and Administration for the following tax matters: 
 
3  Tax Matters 
Type of Tax (Sales, Use, Income, etc.)               Year(s) or Period(s) 
  
4 Acts Authorized 
The representatives are authorized, subject to revocation by the taxpayer, to receive and inspect confidential tax 
information and to perform any and all acts that I (we) can perform with respect to the tax matters described in line 3, 
including the authority to sign any agreements, consents, waivers or other documents. 
 
The authority does not include the power to receive refund checks, the power to substitute another representative, the 
power to sign returns, or the power to execute a request for disclosure of tax returns or return information to a third party. 
 
List any specific additions or deletions to the acts otherwise authorized in this power of attorney: 
 
5  Computer generated notices will continue to be sent to taxpayer as required by law (see instructions). 
 
6    Signature of Taxpayer(s) 
If signed by a corporate officer, partner, guardian, executor, receiver, administrator, or trustee on behalf of the taxpayer, I 
certify that I have the authority to execute this form on behalf of the taxpayer.  If a tax matter concerns a joint return,  
both husband and wife must sign if joint representation is requested.   
If not signed and dated, this power of attorney will be returned. 
 
Singatu r e             D e     T e                 a t                                      itl 
 
Singatu r e             D e     T e                 a t                                      itl 
 
(Revised 08/05) 

                    Instructions for 

  Department of Finance and Administration  

                Power of Attorney form 
                     
PURPOSE 
 The purpose of this form is to authorize an individual to represent you before the 
 Department of Finance and Administration.   
  
AUTHORITY GRANTED 
 This power of attorney form authorizes the representative to perform any and all acts you 
 can perform, with the exception of receiving refund checks, the power to substitute another 
 representative, the power to sign returns, or the power to execute a request for disclosure of 
 tax returns or return information to a third party.   
  
NOTICES TO TAXPAYER 
 The computer generated notices will continue to be sent to you, the taxpayer.  Proposed 
 Assessment and Final Assessment notices are required to be mailed to the taxpayer by law, 
 Arkansas Code Ann §§ 26-18-307, 26-18-403,  and 26-18-401.  You may share these 
 notices with your attorney or other individual that you delegate as your representative. 
  
REVOCATION or Withdrawal of Representative 
 To revoke a Power of Attorney form, mail or fax this form with the date of Revocation in 
 the box in the upper right hand column of the form to the same office it was originally sent.  
 If you do not have a copy of the form, mail or fax a letter stating that you want to revoke 
 the Power of Attorney.  If the taxpayer is revoking the power of attorney, the letter must 
 list the names of the representatives and it must be signed and dated by the taxpayer.  If the 
 representative is withdrawing, list the name, address and Employer Identification number 
 and Sales tax permit number and date of revocation.   
  
WHERE TO FILE 
 Mail or fax the Power of Attorney form to the office handling the tax matter. 
  
The federal Form 2848 may be used in lieu of this form.  (Provided the proper Arkansas tax 
type(s), tax form references, and tax period(s), or year(s) are identified on the federal form.) 

(Revised 08/05)