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INDIVIDUAL ACKNOWLEDGEMENT CORPORATE ACKNOWLEDGEMENT
TO BE FILED ONLY IN CONNECTION WITH MATTERS TO BE FILED ONLY IN CONNECTION WITH MATTERS
INVOLVING AN INDIVIDUAL OR UNINCORPORATED TAXPAYER INVOLVING AN INCORPORATED TAXPAYER
STATE OF STATE OF
SS: SS:
COUNTY OF COUNTY OF
On this _______ day of ________________, _______,
On this _______ day of ________________, _______, before me personally came ___________________________
before me personally came ___________________________ ________________________________________ known to me,
________________________________________ known to me who being duly sworn, deposes and says that he/she resides in
to be the individual described herein, and acknowledged that __________________________________________________;
he/she executed the same. that he/she is the _____________________________________
of _____________________________________________, the
corporation described in and which executed this Power of
SIGNATURE OF NOTARY ADMINISTERING OATH Attorney; and that he/she signed his/her name thereto by order
of the board of directors of the corporation.
EXPIRATION DATE OF APPOINTMENT
SIGNATURE OF NOTARY ADMINISTERING OATH
If you have an
EXPIRATION DATE OF APPOINTMENT
official stamp or →
seal, affix it here.
If you have an
official stamp or →
seal, affix it here.
NOTICE OF APPEARANCE
I agree to represent the above named taxpayer in accordance with the terms of the Power of Attorney set forth above and
I certify that I am a(n):
❑ Attorney-at-Law ❑ Public Accountant
❑ Other: _______________________________
❑ Certified Public Accountant ❑ Enrolled Agent
SIGNATURE DATE
❑ Attorney-at-Law ❑ Public Accountant
❑ Other: _______________________________
❑ Certified Public Accountant ❑ Enrolled Agent
SIGNATURE DATE
❑ Attorney-at-Law ❑ Public Accountant
❑ Other: _______________________________
❑ Certified Public Accountant ❑ Enrolled Agent
SIGNATURE DATE
TAT POA
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