POA                             ALABAMA DEPARTMENT OF LABOR 
rev. 09/2012                   UNEMPLOYMENT COMPENSATION DIVISION 
                               EXPERIENCE RATING SECTION, ROOM 4215 
                                                      MONTGOMERY, AL 36131
                                PHONE: (334) 954-4741/FAX: (334) 956-7496 

                                                      POWER OF ATTORNEY 

KNOW ALL MEN BY THESE PRESENTS: 

THAT _____________________________________________   ACCOUNT NO.______________________,  

a ___________________________________________FEDERAL ID NO._____________________________, 
         (Corporation, partnership, individual, etc.) 

having its principal office at ________________________________________________________, does hereby 

constitute and appoint:  ____________________________________________________ 

                        ____________________________________________________ 

                        ____________________________________________________ 

Representative’s Contact Name: ___________________________                Telephone: __________________ 

its true and lawful attorney in fact with full power and authority to represent the said_____________________, 

before the Alabama Unemployment Compensation Agency until further notice in the following matter(s), to wit: 

(Check appropriate box) 

[     ]  TAX       ----        The filling of reports, payment of contributions, Cost Statements (quarterly), 
         (Limited)             Tax Rate Notices (annually), and any legal documents, i.e. assessments, garnishments, etc., 
                               obtaining other account information as is permissible, (employer reporting data, tax rate  
                               information and liability dates). 

[     ]  BENEFITS ----         Requests for separation, 1st notice of payment of benefits for charge purposes, 
         (Limited)                 employer’s protest of benefit claims and information relative thereto. 

[     ]  TAX AND BENEFITS ---- As described above in the first and second blocks. 
         (Unlimited) 

[     ]  TAX REPORTS ONLY --- The filing of quarterly reports and payment of contributions only. 
         (Limited) 

This authorization cancels and supersedes all prior authorizations associated with the above action checked. 
IN WITNESS WHEREOF, the said______________________________________ has caused this instrument to 

be duly attested by the signature of its duly qualified officer this   day of                      ,           . 

                                                      By:            _______________________________________ 
                                                                              Duly Qualified Officer 

[NOTARY SEAL]                                                              _______________________________________ 
                                                                              Title 

Notary Public