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FORM
                                                                                Power of Attorney
    Wisconsin
   Department of
                                                                                                                                                                             A-222
                                                                                          See instructions on reverse side.
     Revenue
     Part 1                      Taxpayer(s) name(s)                                                                   Social security number(s)        Customer identification number
 (Please type or print)




                          Address (number and street)                                                                  Federal identification number


                          City, state, and ZIP code                                                                    Telephone number – daytime       E-Mail address
                                                                                                                       (        )

     Part 2                       hereby appoint(s) the following individual(s)
                                              Name                                                                    Address                                        Telephone Number
                                                                                                                                                                 (       )
                                                                                                                                                                 (       )
                                                                                                                                                                 (       )
as attorney(s)-in-fact to represent the taxpayer(s) before the Department of Revenue for the tax matter(s) specified in Part(s) 3a and 3b.

Part 3a                                           Type of Tax                 Wisconsin I.D. Number for Tax Checked                   Tax Year(s) or Period(s) Covered

                          Individual Income Tax
                          Corporation Franchise or Income Tax
                          Sales/Use Tax
                          Withholding Tax
                          Other (list type of tax/matter)
Part 3b                           Complete if Power of Attorney is limited to:

                          Field/office audit matters                         Appeal of notice dated
                          All delinquent tax matters                         Other
     Part 4                       Exclusions – Said attorney(s)-in-fact shall, subject to revocation, have authority to receive confidential information and the power to perform on
                                  behalf of the taxpayer(s) any and all acts with respect to the above tax matters except for the following specifically excluded acts:
Attorney-in-fact is not authorized to                                   inspect tax returns/reports
Attorney-in-fact is not authorized to                                   receive notices, assessments, determinations, redeterminations, tax forms, billings, refunds, communications
                                                                        and correspondence containing confidential information
Attorney-in-fact                       is   not   authorized   to       represent the taxpayer(s) at conferences and hearings
Attorney-in-fact                       is   not   authorized   to       execute waivers extending the statutory period of assessment or collection of taxes
Attorney-in-fact                       is   not   authorized   to       execute other acts
Attorney-in-fact                       is   not   authorized   to       use e-mail to send and/or receive confidential tax information with the department
     Part 5
Send notices and other written communications to:                                       Attorney-in-fact              Taxpayer             Both        I understand, agree, and accept:
If only the Attorney-in-fact box is checked, any written communications will be sent to only the attorney-in-fact. If only the Taxpayer box is checked, any written
communications will be sent to only the taxpayer. If no box is checked, any written communications will be sent to only the taxpayer. If the Both box is
checked, all written communications, including extension agreements, will be sent to only the attorney-in-fact, but final actions; for example, assessments,
refunds, and refund denials will be sent to both the attorney-in-fact and the taxpayer. RECEIPT BY EITHER THE ATTORNEY-IN-FACT OR THE
TAXPAYER WILL BE RECEIPT BY BOTH. However, duplicate copies of computer generated sales, withholding and delinquent tax notices and other
written communications cannot be issued due to current system restraints and therefore, these communications will be sent to only the attorney-in-fact.
     Part 6
This Power of Attorney revokes all prior Powers of Attorney on file with the Wisconsin Department of Revenue with respect to the same matters and years
or periods covered by this instrument, except the following:


                                                     (Specify to whom granted, date, and address, or refer to attached copies of prior powers of attorney)
     Part 7
I understand that the execution of this Power of Attorney does not relieve me of personal responsibility for correctly and timely reporting and paying taxes,
or from the penalties for failure to do so, all as provided for under Wisconsin tax law. I understand a photocopy and/or faxed copy of this form has the
same authority as the signed original.

If signed by a corporate officer, partner, or fiduciary on behalf of the taxpayer, I certify that I have the authority to execute this Power of Attorney on behalf
of the taxpayer:
Signature                                                                                           Title                                                      Date


Signature                                                                                           Title                                                      Date



This Power of Attorney is not valid unless signed by the individual(s), corporate officer, partner or fiduciary. Refer to instructions on reverse side.
A-222 (R. 10-03)
INSTRUCTIONS FOR FORM A-222
A Power of Attorney (Form A-222), or other written authorization,             for an indefinite period of time. If the matter relates to estate or
executed by the taxpayer is required by the Wisconsin Department of           inheritance tax, enter the date of the taxpayer’s death instead of the
Revenue in order for the taxpayer’s representative to perform certain         year or period.
acts on behalf of the taxpayer and to receive and inspect certain tax
information. Use of Form A-222 is not mandatory, however, a substi-           Examples:
tute form must reflect the information that would be provided on                • Individual Income Tax 2001
Wisconsin Form A-222. Photocopies and FAX copies of Form A-222                  • Corporation Franchise/Income Tax 1998-2001
are acceptable. E-mail transmissions are not acceptable.
                                                                                • Sales Tax – First and Second Quarter 2000
                                                                                • Withholding Tax – January 1, 2000, until further notice.
The Power of Attorney requirement applies to income, including
individual and fiduciary (estate and trust), corporation income/franchise,      • Other – Homestead Credit Claim – 2001
alternative minimum, withholding, sales and use, inheritance, estate,
motor vehicle fuel, general aviation fuel, alcohol beverages, drug,           Part 3b – Limited Power of Attorney
cigarette and tobacco products, and other tax matters of individuals,
                                                                              If you wish to have this Power of Attorney apply only to specific issues,
partnerships and corporations, including (S) corporations, and to
                                                                              check the appropriate box and complete the line when provided.
recycling fees, and homestead and farmland preservation credit
matters.
                                                                              Examples:
                                                                                • Private Letter Ruling
When the representative is accompanied by the taxpayer or, if the
taxpayer is a corporation, by an officer or authorized employe of the           • Revocation Hearing
corporation, a Power of Attorney is not required for the taxpayer’s             • Claim For Refund
representative to inspect confidential information or to represent the
taxpayer at conferences. Also, a Power of Attorney is generally not           Complete part 3a even though you are completing part 3b.
required for a trustee, receiver, guardian, administrator or executor of an
estate, or a representative appointed by a court.                             Part 4 – Exclusions
                                                                              When the taxpayer does not want to grant complete authority to the
How to Complete Form A-222
                                                                              attorney-in-fact, excluded acts should be identified by checking the
                                                                              appropriate box. If you check the “other acts” box, enter the excluded
Part 1 – Taxpayer Information
                                                                              acts on the line provided. Do not line out portions of the exclusions
A. For individuals: Enter your name, address, social security number,         listed.
   and telephone number in the space provided. If a joint return is
   involved, and you and your spouse are designating the same                 Part 5 – Mailing of Notices and Written Communications
   attorney(s)-in-fact, also enter your spouse’s name and social
                                                                              Check the applicable box(es) to have notices and other written
   security number, and your spouse’s address if different from
                                                                              communications addressed and sent to the taxpayer and/or the
   yours. A federal identification number is not required for individuals.
                                                                              taxpayer’s attorney-in-fact. If more than one representative is listed in
B. For a corporation or partnership: Enter the name, business                 Part 2, indicate with an asterisk (*) in front of the name, who should
   address, federal identification number, and telephone number.              receive the notices and other written communications. Note: duplicate
                                                                              copies of computer generated sales, withholding, and delinquent tax
C. For a trust: Enter the name, title, address, and telephone number
                                                                              notices and other written communications, etc. cannot be issued due
   of the fiduciary, and the name and federal identification number of
                                                                              to current system restraints. All computer generated mailings sent
   the trust.
                                                                              from the sales, withholding, and delinquent tax systems are sent to
D. For an estate: Enter the name, title, address, and telephone               one address, so if the Both box is checked these communications will
   number of the decedent’s personal representative, and the name             be sent to only the attorney-in-fact.
   and identification number of the estate. The identification number
   for an estate includes both the federal identification number if the       Part 6 – Revoking a Power of Attorney
   estate has one and the decedent’s social security number.
                                                                              By filing a new Form A-222 all prior Powers of Attorney filed with the
E. For any other entity: Enter the name, business address, federal            Department of Revenue for the same matters and years or periods are
   identification number, and telephone number.                               revoked unless specifically stated otherwise on the line provided.
   Note: If you have been assigned a customer identification number
                                                                              Part 7 – Signature of Taxpayer(s)
   through the Integrated Tax System that has been implemented by
                                                                              The Power of Attorney form must be signed by the taxpayer; a
   the Wisconsin Department of Revenue, please enter this 10 digit
                                                                              signature stamp is not acceptable.
   number in the appropriate box. Not all tax systems have been
   converted into the Integrated Tax System as yet and therefore a
                                                                              A. Signature of Taxpayer:
   customer identification number may not have been issued to you
   at this time.
                                                                                 1. For individuals: If a joint return is involved and both husband
                                                                                    and wife will be represented by the same individual(s), both
Part 2 – Appointee
                                                                                    spouses must sign the Power of Attorney. If they are to be
Enter the name, address, and telephone number of each individual                    represented by different individuals, each spouse may ex-
appointed as attorney-in-fact.                                                      ecute his or her own Power of Attorney.
                                                                                 2. For partnerships: All partners must sign unless one partner is
Part 3a – Tax Matters and Years or Periods
                                                                                    authorized to act in the name of the partnership.
In the columns provided, identify the type(s) of tax this Power of
                                                                                 3. For a corporation, trust ,estate, or any other entity: A corporate
Attorney authorization applies to by checking the appropriate box(es).
                                                                                    officer or person having authority to bind the entity must sign.
Enter your Wisconsin identification number for each type of tax
checked, and the years or periods for which the Power of Attorney is
                                                                              B. Date: The Power of Attorney should be dated when signed. The
granted. The word “All” for taxes or periods is not specific enough. The
                                                                                 beginning effective date for department action will be the
Power of Attorney can be limited to specific reporting period(s) that
                                                                                 department’s receipt date. The Power of Attorney will remain in
can be stated in year(s), quarter(s), month(s), etc., or can be granted
                                                                                 effect until the department is otherwise notified in writing.

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Form A-222

  • 1. FORM Power of Attorney Wisconsin Department of A-222 See instructions on reverse side. Revenue Part 1 Taxpayer(s) name(s) Social security number(s) Customer identification number (Please type or print) Address (number and street) Federal identification number City, state, and ZIP code Telephone number – daytime E-Mail address ( ) Part 2 hereby appoint(s) the following individual(s) Name Address Telephone Number ( ) ( ) ( ) as attorney(s)-in-fact to represent the taxpayer(s) before the Department of Revenue for the tax matter(s) specified in Part(s) 3a and 3b. Part 3a Type of Tax Wisconsin I.D. Number for Tax Checked Tax Year(s) or Period(s) Covered Individual Income Tax Corporation Franchise or Income Tax Sales/Use Tax Withholding Tax Other (list type of tax/matter) Part 3b Complete if Power of Attorney is limited to: Field/office audit matters Appeal of notice dated All delinquent tax matters Other Part 4 Exclusions – Said attorney(s)-in-fact shall, subject to revocation, have authority to receive confidential information and the power to perform on behalf of the taxpayer(s) any and all acts with respect to the above tax matters except for the following specifically excluded acts: Attorney-in-fact is not authorized to inspect tax returns/reports Attorney-in-fact is not authorized to receive notices, assessments, determinations, redeterminations, tax forms, billings, refunds, communications and correspondence containing confidential information Attorney-in-fact is not authorized to represent the taxpayer(s) at conferences and hearings Attorney-in-fact is not authorized to execute waivers extending the statutory period of assessment or collection of taxes Attorney-in-fact is not authorized to execute other acts Attorney-in-fact is not authorized to use e-mail to send and/or receive confidential tax information with the department Part 5 Send notices and other written communications to: Attorney-in-fact Taxpayer Both I understand, agree, and accept: If only the Attorney-in-fact box is checked, any written communications will be sent to only the attorney-in-fact. If only the Taxpayer box is checked, any written communications will be sent to only the taxpayer. If no box is checked, any written communications will be sent to only the taxpayer. If the Both box is checked, all written communications, including extension agreements, will be sent to only the attorney-in-fact, but final actions; for example, assessments, refunds, and refund denials will be sent to both the attorney-in-fact and the taxpayer. RECEIPT BY EITHER THE ATTORNEY-IN-FACT OR THE TAXPAYER WILL BE RECEIPT BY BOTH. However, duplicate copies of computer generated sales, withholding and delinquent tax notices and other written communications cannot be issued due to current system restraints and therefore, these communications will be sent to only the attorney-in-fact. Part 6 This Power of Attorney revokes all prior Powers of Attorney on file with the Wisconsin Department of Revenue with respect to the same matters and years or periods covered by this instrument, except the following: (Specify to whom granted, date, and address, or refer to attached copies of prior powers of attorney) Part 7 I understand that the execution of this Power of Attorney does not relieve me of personal responsibility for correctly and timely reporting and paying taxes, or from the penalties for failure to do so, all as provided for under Wisconsin tax law. I understand a photocopy and/or faxed copy of this form has the same authority as the signed original. If signed by a corporate officer, partner, or fiduciary on behalf of the taxpayer, I certify that I have the authority to execute this Power of Attorney on behalf of the taxpayer: Signature Title Date Signature Title Date This Power of Attorney is not valid unless signed by the individual(s), corporate officer, partner or fiduciary. Refer to instructions on reverse side. A-222 (R. 10-03)
  • 2. INSTRUCTIONS FOR FORM A-222 A Power of Attorney (Form A-222), or other written authorization, for an indefinite period of time. If the matter relates to estate or executed by the taxpayer is required by the Wisconsin Department of inheritance tax, enter the date of the taxpayer’s death instead of the Revenue in order for the taxpayer’s representative to perform certain year or period. acts on behalf of the taxpayer and to receive and inspect certain tax information. Use of Form A-222 is not mandatory, however, a substi- Examples: tute form must reflect the information that would be provided on • Individual Income Tax 2001 Wisconsin Form A-222. Photocopies and FAX copies of Form A-222 • Corporation Franchise/Income Tax 1998-2001 are acceptable. E-mail transmissions are not acceptable. • Sales Tax – First and Second Quarter 2000 • Withholding Tax – January 1, 2000, until further notice. The Power of Attorney requirement applies to income, including individual and fiduciary (estate and trust), corporation income/franchise, • Other – Homestead Credit Claim – 2001 alternative minimum, withholding, sales and use, inheritance, estate, motor vehicle fuel, general aviation fuel, alcohol beverages, drug, Part 3b – Limited Power of Attorney cigarette and tobacco products, and other tax matters of individuals, If you wish to have this Power of Attorney apply only to specific issues, partnerships and corporations, including (S) corporations, and to check the appropriate box and complete the line when provided. recycling fees, and homestead and farmland preservation credit matters. Examples: • Private Letter Ruling When the representative is accompanied by the taxpayer or, if the taxpayer is a corporation, by an officer or authorized employe of the • Revocation Hearing corporation, a Power of Attorney is not required for the taxpayer’s • Claim For Refund representative to inspect confidential information or to represent the taxpayer at conferences. Also, a Power of Attorney is generally not Complete part 3a even though you are completing part 3b. required for a trustee, receiver, guardian, administrator or executor of an estate, or a representative appointed by a court. Part 4 – Exclusions When the taxpayer does not want to grant complete authority to the How to Complete Form A-222 attorney-in-fact, excluded acts should be identified by checking the appropriate box. If you check the “other acts” box, enter the excluded Part 1 – Taxpayer Information acts on the line provided. Do not line out portions of the exclusions A. For individuals: Enter your name, address, social security number, listed. and telephone number in the space provided. If a joint return is involved, and you and your spouse are designating the same Part 5 – Mailing of Notices and Written Communications attorney(s)-in-fact, also enter your spouse’s name and social Check the applicable box(es) to have notices and other written security number, and your spouse’s address if different from communications addressed and sent to the taxpayer and/or the yours. A federal identification number is not required for individuals. taxpayer’s attorney-in-fact. If more than one representative is listed in B. For a corporation or partnership: Enter the name, business Part 2, indicate with an asterisk (*) in front of the name, who should address, federal identification number, and telephone number. receive the notices and other written communications. Note: duplicate copies of computer generated sales, withholding, and delinquent tax C. For a trust: Enter the name, title, address, and telephone number notices and other written communications, etc. cannot be issued due of the fiduciary, and the name and federal identification number of to current system restraints. All computer generated mailings sent the trust. from the sales, withholding, and delinquent tax systems are sent to D. For an estate: Enter the name, title, address, and telephone one address, so if the Both box is checked these communications will number of the decedent’s personal representative, and the name be sent to only the attorney-in-fact. and identification number of the estate. The identification number for an estate includes both the federal identification number if the Part 6 – Revoking a Power of Attorney estate has one and the decedent’s social security number. By filing a new Form A-222 all prior Powers of Attorney filed with the E. For any other entity: Enter the name, business address, federal Department of Revenue for the same matters and years or periods are identification number, and telephone number. revoked unless specifically stated otherwise on the line provided. Note: If you have been assigned a customer identification number Part 7 – Signature of Taxpayer(s) through the Integrated Tax System that has been implemented by The Power of Attorney form must be signed by the taxpayer; a the Wisconsin Department of Revenue, please enter this 10 digit signature stamp is not acceptable. number in the appropriate box. Not all tax systems have been converted into the Integrated Tax System as yet and therefore a A. Signature of Taxpayer: customer identification number may not have been issued to you at this time. 1. For individuals: If a joint return is involved and both husband and wife will be represented by the same individual(s), both Part 2 – Appointee spouses must sign the Power of Attorney. If they are to be Enter the name, address, and telephone number of each individual represented by different individuals, each spouse may ex- appointed as attorney-in-fact. ecute his or her own Power of Attorney. 2. For partnerships: All partners must sign unless one partner is Part 3a – Tax Matters and Years or Periods authorized to act in the name of the partnership. In the columns provided, identify the type(s) of tax this Power of 3. For a corporation, trust ,estate, or any other entity: A corporate Attorney authorization applies to by checking the appropriate box(es). officer or person having authority to bind the entity must sign. Enter your Wisconsin identification number for each type of tax checked, and the years or periods for which the Power of Attorney is B. Date: The Power of Attorney should be dated when signed. The granted. The word “All” for taxes or periods is not specific enough. The beginning effective date for department action will be the Power of Attorney can be limited to specific reporting period(s) that department’s receipt date. The Power of Attorney will remain in can be stated in year(s), quarter(s), month(s), etc., or can be granted effect until the department is otherwise notified in writing.