Fill - Free fillable and Declaration of Representative POWER OF ATTORNEY Florida (ADP) PDF form

PART I - POWER OF ATTORNEY

Florida Department of Revenue

POWER OF ATTORNEY

and Declaration of Representative

Section 1. Taxpayer Information. Taxpayer(s) must sign and date this form on Page 2, Part I, Section 8.

Taxpayer name(s) and address(es) Federal ID no(s). (SSN*, FEIN, etc.) Florida Tax Registration Number(s)

(Business Part. No., Sales Tax No., R.T. Acct No., etc.)

Contact person

Telephone number ( )

Fax number ( )

The Taxpayer(s) hereby appoint(s) the following representative(s) as attorney(s)-in-fact:

Section 2. Representative(s). Each representative must be listed individually, and must sign and date this form on Page 2, Part II.

Name and address (include name of rm if applicable)

E-mail address:

Telephone number ( )

Fax number ( )

Cell phone number ( )

Name and address (include name of rm if applicable)

E-mail address:

Telephone number ( )

Fax number ( )

Cell phone number ( )

Name and address (include name of rm if applicable)

E-mail address:

Telephone number ( )

Fax number ( )

Cell phone number ( )

To represent the taxpayer(s) before the Florida Department of Revenue in the following tax matters:

Section 3. Tax Matters. Do not complete this section if completing Section 4.

Type of Tax (Corporate, Sales, Reemployment, formerly Unemployment, etc.) Year(s) / Period(s) Tax Matter(s) (Tax Audits, Protests, Refunds, etc.)

Section 4. To Appoint a Reemployment Tax (formerly Unemployment Tax) Agent Only. Do not complete Sections 3 and 6 if

completing Section 4.

By completing this section, an employer (taxpayer) appoints a representative to act as its Florida reemployment tax agent before the Florida

Department of Revenue on a continuing basis and to receive condential information with respect to mailings, lings, and other tax matters related

to the Florida reemployment assistance program law. All other sections of this form (except Sections 3 and 6) must also be completed. Do not

complete Section 4 unless you wish to appoint a reemployment tax agent on a continuing basis.

Agent name Agent number (required)

Firm name Federal I.D. No. (required)

Address (if different from above) Telephone number ( )

Mail Type: See Instructions for explanations. Check one box only. ❑ 1 (Primary) ❑ 2 (Reporting) ❑ 3 (Rate) ❑ 4 (Claim)

Section 5. Acts Authorized.

The representative(s) are authorized to receive and inspect condential tax information and to perform any and all acts that I (we) can perform with

respect to the tax matters described in Section 3 and Section 4 (for example, the authority to sign any agreements, consents, or other documents).

Except as otherwise provided, the authority specically includes the power to execute waivers of restrictions on assessment or collection of

deciencies in tax, to execute consents extending the statutory period for assessment or claims for refund of taxes, and to execute closing agreements

under section 213.21, Florida Statutes. This authority does not include the power to endorse or cash warrants, or the power to sign certain returns.

If you want to authorize a representative named in Section 2 to receive (but not to endorse or cash) refund warrants, write the name of the

representative on this line and check the box ........................➧ ____________________________________________________________________________ ❑

List any specic limitations or deletions to the acts otherwise authorized in this Power of Attorney.

______________________________________________________________________________________________________________________________________

DR-835

R. 10/11

Rule 12-6.0015

Florida Administrative Code

Effective 01/12

See Instructions for additional information.

Clear Form

SAVE

UIDOCS@ADPUNEMPLOYMENTCLAIMS.COM

855 537-8499

ADP, LLC, and its subsidiaries and Corporate Cost Control, LLC.

The parties may be addressed collectively as ADP NEW HAMPSHIRE.

PO BOX 16440, CLEARWATER FL 33766-6440

855 537-8536

Unemployment.

Current and Past

Tax Audits, Tax Rate Notices, Credits &

Debits, Refunds, Claims, Benefit Charges,

Hearings & Protests.

ADP Unemployment Claims

13-3036745

PO BOX 16440 CLEARWATER FL 33766-6440

855 537-8499

PART II - DECLARATION OF REPRESENTATIVE

Florida Tax Registration Number:

Taxpayer Name(s): Federal Identication Number:

• Taxpayer(s) must complete Page 1 of this Power of Attorney or it will not be processed.

Section 6. Notices and Communication. Do not complete Section 6 if completing Section 4.

• Notices and other written communications will be sent to the rst representative listed in Part I, Section 2, unless the taxpayer selects one of the

options below. Receipt by either the representative or the taxpayer will be considered receipt by both.

a. If you want notices and communications sent to both you and your representative, check this box .................................➧ ❑

b. If you want notices or communications sent to you and not your representative, check this box ...................................... ➧ ❑

Certain computer-generated notices and other written communications cannot be issued in duplicate due to current system constraints. Therefore, we

will send these communications to only the taxpayer at his or her tax registration address.

Section 7. Retention / Nonrevocation of Prior Power(s) of Attorney.

The ling of this Power of Attorney will not revoke earlier Power(s) of Attorney on le with the Florida Department of Revenue,

even for the same tax matters and years or periods covered by this document. If you want to revoke a prior Power of

Attorney, check this box ............................................................................................................................................... ➧ ❑

You must attach a copy of any Power of Attorney you wish to revoke.

Section 8. Signature of Taxpayer(s).

If a tax matter concerns a joint return, both husband and wife must sign if joint representation is requested. If signed by a corporate ofcer,

partner, member/managing member, guardian, tax matters partner/person, executor, receiver, administrator, trustee, or duciary on behalf of the

taxpayer, I declare under penalties of perjury that I have the authority to execute this form on behalf of the taxpayer.

Under penalties of perjury, I (we) declare that I (we) have read the foregoing document, and the facts stated in it are true.

If this Power of Attorney is not signed and dated, it will be returned.

_______________________________________________________________________________________ ________________________________________ _________________________________________

Signature Date Title (if applicable)

_______________________________________________________________________________________

Print name

_______________________________________________________________________________________ ________________________________________ _________________________________________

Signature Date Title (if applicable)

_______________________________________________________________________________________

Print name

Under penalties of perjury, I declare that:

• I am familiar with the mandatory standards of conduct governing representation before the Department of Revenue, including Rules 12-6.006

and 28-106.107 of the Florida Administrative Code, as amended.

• I am familiar with the law and facts related to this matter and am qualied to represent the taxpayer(s) in this matter.

• I am authorized to represent the taxpayer(s) identied in Part I for the tax matter(s) specied therein, and to receive and inspect condential

taxpayer information.

• I am one of the following:

a. Attorney - a member in good standing of the bar of the highest court of the jurisdiction shown below.

b. Certied Public Accountant - duly qualied to practice as a certied public accountant in the jurisdiction shown below.

c. Enrolled Agent – enrolled as an agent pursuant to the requirements of Treasury Department Circular Number 230.

d. Former Department of Revenue Employee. As a representative, I cannot accept representation in a matter upon which I had direct

involvement while I was a public employee.

e. Reemployment Tax Agent authorized in Section 4 of this form.

f. Other Qualied Representative.

• I have read the foregoing Declaration of Representative and the facts stated in it are true.

If this Declaration of Representative is not signed and dated, it will not be processed.

Designation – Insert

Letter from Above (a -f)

Jurisdiction (State) and

Enrollment Card No. (if any)

Signature Date

DR-835

R. 10/11

Page 2

DR-835

R. 10/11

Page 3

Purpose of this form

A Power of Attorney (Form DR-835) signed by the taxpayer and the

representative is required by the Florida Department of Revenue

in order for the taxpayer’s representative to perform certain acts

on behalf of the taxpayer and to receive and inspect condential

tax information. You and your representative must complete, sign,

and return Form DR-835 if you want to grant Power of Attorney

to an attorney, certied public accountant, enrolled agent, former

Department employee, reemployment tax agent, or any other qualied

individual. A Power of Attorney is a legal document authorizing

someone other than yourself to act as your representative.

You may use this form for any matters affecting any tax administered

by the Department of Revenue. This includes both the audit and

collection processes. A Power of Attorney will remain in effect until

you revoke it. If you provide more than one Power of Attorney with

respect to a tax and tax period, the Department employee handling

your case will address notices and correspondence relative to that

issue to the rst person listed on the latest Power of Attorney.

A Power of Attorney Form is generally not required, if the

representative is, or is accompanied by: a trustee, a receiver, an

administrator, an executor of an estate, a corporate ofcer, or an

authorized employee of the taxpayer.

Photocopies and fax copies of Form DR-835 are usually acceptable.

E-mail transmissions or other types of Powers of Attorney are not

acceptable. Copies of Form DR-835 are readily available by visiting

our Internet site (www.myorida.com/dor/forms).

How to Complete Form DR-835, Power of Attorney

PART I POWER OF ATTORNEY

Section 1 – Taxpayer Information

• For individuals and sole proprietorships: Enter your name,

address, social security number, and telephone number(s) in the

spaces provided. Enter your federal employer identication number

(FEIN), if you have one. If a joint return is involved, and you and

your spouse are designating the same attorney(s)-in-fact, also enter

your spouse’s name and social security number, and your spouse’s

address if different from yours.

• For a corporation, limited liability company, or partnership:

Enter the name, business address, FEIN, a contact person familiar

with this matter, and telephone number(s).

• For a trust: Enter the name, title, address, and telephone

number(s) of the duciary, and name and FEIN of the trust.

• For an estate: Enter the name, title, address, and telephone

number(s) of the decedent’s personal representative, and the name

and identication number of the estate. The identication number

for an estate includes both the FEIN if the estate has one and the

decedent’s social security number.

• For any other entity: Enter the name, business address, FEIN,

and telephone number(s), as well as the name of a contact person

familiar with this matter.

• Identication Number: The Department may have assigned you

a Florida tax registration number such as a sales tax number, a

reemployment tax account number, or a business partner number.

These numbers further assist the Department in identifying your

particular tax matter, and you should enter them in the appropriate

box. If you do not provide this information, the Department may not

be able to process the Power of Attorney.

POWER OF ATTORNEY INSTRUCTIONS

Section 2 – Representative(s)

Enter the individual name, rm name (if applicable), address,

telephone number(s), and fax number of each individual appointed as

attorney-in-fact and representative. If the representatives have the

same address, simply write “same” in the appropriate box. If you wish

to appoint more than three representatives, you should attach a letter

to Form DR-835 listing those additional individuals.

Section 3 – Tax Matters

Enter the type(s) of tax this Power of Attorney authorization applies to

and the years or periods for which the Power of Attorney is granted.

The word “All” is not specic enough. If your tax situation does not t

into a tax type or period (for example, a specic administrative appeal,

audit, or collection matter), describe it in the blank space provided

for “Tax Matters.” The Power of Attorney can be limited to specic

reporting period(s) that can be stated in year(s), quarter(s), month(s),

etc., or can be granted for an indenite period. You must indicate

the tax types, periods, and/or matters for which you are authorizing

representation by your attorney-in-fact.

Examples:

Sales and Use Tax First and second quarter 2008

Corporate Income Tax 7/1/07 – 6/30/08

Communications Services Tax 2006 thru 2008

Insurance Premium Tax 1/1/06 – 12/31/08

Technical Assistance Advisement Request dated 8/6/08

Claim for Refund 3/7/07

Section 4 – To Appoint a Reemployment Tax Agent

Complete this section only if you wish to appoint an agent for

reemployment taxes on a continuing basis. You should not complete

Section 3 or Section 6, but you must complete the remaining sections

of Form DR-835.

Enter the agent’s name. It must be the same name as found in

Section 2. Enter the rm name and address. You do not need to

complete the address line if you reported that information in Section 2.

1. Enter the agent number. The agent number is a seven-digit

number assigned by the Department of Revenue.

2. Enter the federal employer identication number. The FEIN is a

nine-digit number assigned to the agent by the Internal Revenue

Service.

3. Select the mail type.

Primary Mail. If you select primary mail, the agent will receive

all documents from the Department of Revenue related to this

reemployment tax account, and will be authorized to receive

condential information and discuss matters related to the tax and

wage report, benet information, claims, and the employer’s rate.

Reporting Mail. If you select reporting mail, the agent will receive

the Employer’s Quarterly Report (Form RT-6), certication, and

correspondence related to reporting. The agent will be authorized to

receive condential information and discuss the tax and wage report,

certication, and correspondence with the Department.

Rate Mail. If you select rate mail, the agent will receive tax rate

notices and correspondence related to the rate and will be authorized

to receive condential information and discuss the employer’s rate

notices and rate with the Department.

Claims Mail. If you select claims mail, the agent will receive the

notice of benets paid, and will be authorized to receive condential

information and discuss matters related to benets.

Note: Duplicate copies of certain computer-generated notices and

other written communications cannot be issued due to current system

constraints and therefore, these communications will be sent only to

the representative.

DR-835

R. 10/11

Page 4

Note: If you wish to appoint a representative to act on your behalf in

a specic and non-continuing reemployment tax matter, you should

complete Section 3 and Section 6 and not Section 4. For example,

if you hire a representative to assist you with a single matter, such as

a reemployment tax audit or contesting the payment of a claim, and

wish that representative to handle just that one matter, you should

not complete Section 4 to authorize that representation. Instead, you

should ll out Section 3 and specify the exact matter the representative

is handling.

Section 5 – Acts Authorized

Your signature on the back of the Power of Attorney authorizes the

individual(s) you designate (your representative or “attorney-in-fact”)

to perform any act you can perform with respect to your tax matters,

except that your representative may not sign certain returns for you

nor may your representative negotiate or cash your refund warrant.

This authority includes signing consents to a change in tax liability,

consents to extend the time for assessing or collecting tax, closing

agreements, and compromises. You may authorize your representative

to receive, but not negotiate or cash, your refund warrant by checking

the box in Section 5 and writing the name of the representative on the

line below. If you wish to limit the authority of your representative other

than in the manner previously described, you must describe those

limits on the lines provided in Section 5.

Section 6 – Mailing of Notices and Communications

If you do not check a box, the Department will send notices and other

written communications to the rst representative listed in Section 2,

unless you select another option. If you wish to have no documents

sent to your representative, or documents sent to both you and your

representative, you should check the appropriate box in Section 6.

Check the second box if you wish to have notices and other written

communications sent to you and not to your representative. In

certain instances, the Department can only send documents to the

taxpayer. Therefore, the taxpayer has the responsibility of keeping the

representative informed of tax matters.

Note: Taxpayers completing Section 4 (To Appoint a Reemployment

Tax Agent Only) should not complete Section 6. See Section 4 of these

instructions for information regarding notices and communications sent

to a reemployment tax agent.

Section 7 – Retention/Nonrevocation of Prior Power(s) of Attorney

The most recent Power of Attorney will take precedence over, but will

not revoke, prior Powers of Attorney. If you wish to revoke a prior

Power of Attorney, you must check the box on the form and attach a

copy of the old Power of Attorney.

Section 8 – Signature of Taxpayer(s)

The Power of Attorney is not valid until signed and dated by the

taxpayer. The individual signing the Power of Attorney is representing,

under penalties of perjury, that he or she is the taxpayer or authorized

to execute the Power of Attorney on behalf of the taxpayer.

• For a corporation, trust, estate, or any other entity: A corporate

ofcer or person having authority to bind the entity must sign.

• For partnerships: All partners must sign unless one partner is

authorized to act in the name of the partnership.

• For a sole proprietorship: The owner of the sole proprietorship

must sign.

• For a joint return: Both husband and wife must sign if the

representative represents both. If the representative only

represents one spouse, then only that spouse should sign.

PART II – DECLARATION OF REPRESENTATIVE

Any party who appears before the Department of Revenue has the

right, at his or her own expense, to be represented by counsel or by a

qualied representative. The representative(s) you name must declare,

under penalties of perjury, that he or she is qualied to represent you in

this matter and will comply with the mandatory standards of conduct

governing representation before the Department of Revenue. The

representative(s) must also declare, under penalties of perjury, that he

or she has been authorized to represent the taxpayer(s) in this matter

and authorized by the taxpayer(s) to receive condential taxpayer

information.

The representative(s) you name must sign and date this declaration

and enter the designation (i.e., items a-f) under which he or she is

authorized to represent you before the Department of Revenue.

a. Attorney – Enter the two-letter abbreviation for the state (for

example “FL” for Florida) in which admitted to practice, along with

your bar number.

b. Certied Public Accountant – Enter the two-letter abbreviation

for the state (for example “FL” for Florida) in which licensed to

practice.

c. Enrolled Agent – Enter the enrollment card number issued by the

Internal Revenue Service.

d. Former Department of Revenue Employee – Former employees

may not accept representation in matters in which they were

directly involved, and in certain cases, on any matter for a period

of two years following termination of employment. If a former

Department of Revenue employee is also an attorney or CPA,

then the additional designation, jurisdiction, and enrollment card

should also be entered.

e. Reemployment Tax Agent – A person(s) appointed under

Section 4 of the Power of Attorney to handle reemployment tax

matters on a continuing basis. A separate Power of Attorney

form must be completed in order for a reemployment tax agent to

handle a specic and non-continuing matter such as a protest of a

reemployment tax rate.

f. Other Qualied Representative – An individual may represent

a taxpayer before the Department of Revenue if training and

experience qualies that person to handle a specic matter.

Rule 28-106.107, Florida Administrative Code, sets out mandatory

standards of conduct for all qualied representatives. A representative

shall not:

(a) Engage in conduct involving dishonesty, fraud, deceit, or

misrepresentation.

(b) Engage in conduct that is prejudicial to the administration of

justice.

that he or she is not competent to handle.

(d) Handle a legal or factual matter without adequate preparation.

*Social security numbers (SSNs) are used by the Florida

Department of Revenue as unique identiers for the administration of

Florida’s taxes. SSNs obtained for tax administration purposes are

condential under sections 213.053 and 119.071, Florida Statutes,

and not subject to disclosure as public records. Collection of your

SSN is authorized under state and federal law. Visit our Internet

site at www.myorida.com/dor and select “Privacy Notice” for

more information regarding the state and federal law governing the

collection, use, or release of SSNs, including authorized exceptions.

Where to Mail Form DR-835

If Form DR-835 is for a specic matter, mail or fax it to the ofce or

employee handling the specic matter. You may send it with the

document to which it relates.

If Form DR-835 is for a reemployment tax matter and the taxpayer has

completed Section 4, mail it to the Florida Department of Revenue,

P.O. Box 6510, Tallahassee FL 32314-6510, or fax it to 850-488-5997.

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

and Declaration of Representative POWER OF ATTORNEY Florida (ADP)

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank and Declaration of Representative POWER OF ATTORNEY Florida (ADP) Form

Related forms

Fillable and Declaration of Representative POWER OF ATTORNEY Florida (ADP)

Fill Online, Printable, Fillable, Blank and Declaration of Representative POWER OF ATTORNEY Florida (ADP) Form

Related forms

First 20 documents completely FREE!