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Michigan Department of Treasury                                                                           Issued under authority of Public Act 122 of 1941. 
151 (Rev. 07-19) 

Authorized Representative Declaration (Power of Attorney) 
INSTRUCTIONS: Use this form to authorize the Michigan Department of Treasury to communicate with a named individual or entity acting 
on your behalf.  Also use this form to designate a representative to receive copies of correspondence regarding a particular tax dispute 
(other than City Income Tax).  All information designated as “required” must be supplied for this authorization to be effective. 
PART 1: TAXPAYER OR DEBTOR INFORMATION 
Taxpayer’s Name (Required) If a business, include any DBA, trade or FEIN, ME or TR Number (Required for business taxes) 
assumed name. If filing joint return, include spouse’s name. 

Taxpayer or Business Address (Required)                             Taxpayer’s Social Security Number (Required if Spouse’s Social Security Number 
                                                                    no FEIN, ME, or TR Number listed) 

Taxpayer’s E-mail Address                                           Daytime Telephone Number (Required)            Fax Number 

PART 2: REVOCATION OF AUTHORITY 
To revoke the authority of your current representative, check the applicable box in this section. Check only ONE box. 
I revoke all prior authorizations. I will represent myself. 
I revoke prior authorizations in the matter/dispute listed in Part 4 and/or Part 5. I will represent myself. 
I revoke prior authorizations in the matter/dispute listed in Part 4 and/or Part 5 and appoint a new representative in Part 3 who is authorized 
under Part 4 and/or 5. 
PART 3: REPRESENTATIVE APPOINTMENT 
Your representative may be an entity or an individual. If you designate an entity you must also provide an individual as a contact.  If no start date is 
indicated the authorization is effective as of the date this form is signed.  If no expiration date is indicated the authorization is effective until revoked. 
Authorized Representative’s Name (Required)                         Contact Name (Required if an entity is named) 

Authorized Representative’s Address (Required)                      Telephone Number (Required)                    Fax Number 

                                                                    Authorization Start Date (mm/dd/yyyy)          Authorization Expiration Date (mm/dd/yyyy) 

                                                                    Authorized Representative’s E-mail Address 

PART 4: TYPE OF AUTHORITY 
If you check a box, you authorize your representative to act in that capacity. 
1. Receive         and inspect confidential information (upon request only). (To have your representative receive copies of all future letters and 
          notices involving a tax dispute [other than City Income Tax], you must complete Part 5.) 
2. Make oral or written presentation of fact or argument. 
3. Sign returns.                                                      You may restrict authority in boxes 1-4 to a specific matter (Not required) 
                                                                      Tax Type, Debt or Fee                              Year(s) or period(s) 
4. Enter into agreements. 
5. All of the above. 
PART 5: REQUEST COPIES OF LETTERS AND NOTICES REGARDING A TAX DISPUTE (other than City Income Tax) 
By checking this box, you are directing Treasury to send a copy of all future notices and letters involving a particular tax dispute to your        
representative named in Part 3 under section 8 of the Revenue Act (MCL205.8). This dispute is for year(s) or period(s) __________________  and  
Tax (income tax, sales tax, use tax, etc.)_________________________________________________________ (Tax and year(s) or period(s) 
are both required if this box is checked.) 

PART 6: TAXPAYER OR DEBTOR AUTHORIZATION 
By signing this form, I authorize Treasury to communicate with my representative consistent with the authority granted. 
Signature (Required)                           Print Name (Required)                      Title (Required if a business) Date (Required) 

Spouse’s Signature                             Print Name                                 Title                          Date (Required if spouse signs) 

                                                              TREASURY USE ONLY 
          Accepted              Rejected                                         Division Name                                  Reviewer Initials

Form 151, Page 2 

Purpose 
Use the Authorized Representative Declaration (Power  of             Part 5: Requesting copies of letters and notices with 
Attorney) (Form 151) to authorize the Michigan Department            respect to a tax dispute.   
of Treasury (Treasury) to communicate  with a  named                 NOTE: This part does not apply to City Income Tax. 
individual  or  entity  acting on your  behalf.   This form  may 
also be used to revoke your representative’s authority or to         If you complete Part 5, you must identify on the line in Part 5 
designate a representative to receive letters and notices            a single tax matter that is in dispute. The dispute may cover 
regarding a particular tax dispute.                                  more than one tax period or year.   If you have more than 
                                                                     one dispute with Treasury and want your representative 
Required   information. If  a  box includes the  word                to receive copies of future notices and letters with respect 
“Required,” you must provide the information.  If a box does         to those additional disputes, you must fill out a separate 
not contain the required information, the form is invalid and        form for each dispute.  Part 5 does not give a representative 
you will be notified by letter.                                      authority to act on your behalf.  You must give your 
Part 2: Revoking the authority of a representative.                  representative  authority  to  act  on  your  behalf  by  checking 
Complete Part 2 if you want to revoke your representative’s          one or more boxes in Part 4 if you want your representative 
authority in whole or in part or all prior authorizations. After     to do more than just receive future notices and letters.  Only 
you revoke your representative’s authority, you may represent        one representative can be authorized to receive future letters 
yourself, or you may appoint a new representative.                   and notices regarding a specific tax dispute under Part 5. 
Part 3: Appointing an entity as your representative.                 Treasury will only send future letters and notices to the 
If you appoint an entity as your representative, then any            person identified on the most recent form.  If you appoint an 
individual within that entity is authorized to act on your           entity as your representative, future letters and notices will 
behalf. For example, if you appoint the XYZ Law Firm as              be sent to the attention of the first “Contact Name.” 
your representative, any attorney or paralegal from that firm        Deceased taxpayer. Do not use this form for a deceased 
is authorized to act on your behalf.  The “Contact Name” is          taxpayer. File a Claim for Refund Due a Deceased Taxpayer 
only to ensure that information sent to the entity is directed       (MI-1310) with a death certificate and/or a letter of authority 
to the individual overseeing your representation.  The contact       (issued by the probate court) for a personal representative.  
name is NOT your sole authorized representative.  To appoint 
an entity, write in the Name and Address box (for example):          MAILING OR FAXING INSTRUCTIONS 
     XYZ Law Firm                                                    Individual taxpayers: 
     1234 Street                                                     Michigan Department of Treasury
     City, State, ZIP Code                                           Customer Contact Center 
                                                                     Individual Correspondence Section
Appointing an individual as your representative. If you              P.O. Box 30058 
appoint a specific individual as your representative, then only      Lansing, Ml 48909
that individual is authorized to act on your behalf. Treasury        Fax: 517-636-4488 
will only discuss with or disclose information to that 
individual.  For  example,  if a  specific  attorney  at  the  XYZ 
                                                                     When Treasury Collections asks for this form and any 
Law Firm is named as your representative, Treasury will not 
                                                                     attachments:  
discuss with or disclose information to any other attorney or 
paralegal at the same firm.  To appoint an individual, write in      Michigan Department of Treasury — Coll
the Name and Address box (for example):                              P.O. Box 30149 
                                                                     Lansing, Ml  48909 
     Lynn Lee                                                        Fax: 517-272-5562 
     XYZ Law Firm 
     1234 Street 
     City, State, ZIP Code                                           When a Treasury field office representative asks for this 
                                                                     form, send it as directed by that office. 
Part 4: Type of authority: General or limited. You may 
grant your representative general or limited authority to act 
on your behalf. The actions that your representative may             For all others: 
take will depend on the boxes that you check in Part 4.              Michigan Department of Treasury 
Confidential information (box 1) will only be provided upon          Customer Contact Center 
request;  Treasury will not  automatically send confidential         Registration Section
information  to  your  representative.    If  you  check  box  5  in P.O. Box 30778 
Part 4, you are granting your representative general authority       Lansing, Ml 48909 
to act on your behalf regarding any tax return and any debt.         Fax: 517-636-4520
However, granting your representative general authority does 
not give the representative the right to receive future copies 
of letters and notices unless Part 5 is also completed.