POA                                                       ALABAMA DEPARTMENT OF LABOR 
rev. 09/201  8                                   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:  ____________________________________________________(Name of Representative Company) (Rep ID No.)

                       ____________________________________________________(Mailing Address of Representative Company)

                       ____________________________________________________(City, State, and Zip of Representative Company
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