Fillable Printable BOE-392 - California Power of Attorney Form

BOE-392 - California Power of Attorney Form

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BOE-392 (FRONT) REV. 9 (3-11)

POWER OF ATTORNEY

STATE OF CALIFORNIA

BOARD OF EQUALIZATION

FRANCHISE TAX BOARD

EMPLOYMENT DEVELOPMENT DEPARTMENT

Check below to indicate the appropriate agency. Please note that a separate form must be completed and provided to each agency checked.

STATE BOARD OF EQUALIZATION

PO BOx 942879

SACRAMENTO CA 94279-0001

800-400-7115

FRANCHISE TAx BOARD

PO BOx 2828 MS F283

RANCHO CORDOVA CA 95741-2828

FAx 916-843-5440

EMPLOYMENT DEVELOPMENT DEPARTMENT

PO BOx 826880 MIC 28

SACRAMENTO CA 94280-0001

916-654-7263 • FAx 916-654-9211

TAXPAYER’S NAME

BUSINESS OR CORPORATION NAME

TELEPHONE NUMBER

( )

FAX NUMBER

( )

SOCIAL SECURITY NUMBER FEDERAL EMPLOYER IDENTIFICATION NUMBER(S) CALIFORNIA SECRETARY OF STATE NUMBER(S)

BOARD OF EQUALIZATION ACCOUNT/PERMIT(S) EDD EMPLOYER ACCOUNT NUMBER

MAILING ADDRESS (Number and Street, City, State, ZIP Code)

INDIVIDUAL PARTNERSHIP CORPORATION LIMITED LIABILITY COMPANY

OTHER

As owner, ofﬁcer, receiver, administrator, or trustee for the taxpayer, or as a party to the tax or fee matter before the:

State Board of Equalization Franchise Tax Board Employment Development Department

I hereby appoint: [enter below the individual appointee(s) name(s), address(es) (including ZIP Code), telephone number(s) and fax number(s)

– do not enter names of accounting or law ﬁrms, partnerships, corporations, etc., as the appointee name] �

APPOINTEE NAME

APPOINTEE BUSINESS NAME (If applicable)

APPOINTEE ADDRESS (Number and Street)

(City) (State) (ZIP Code)

TELEPHONE NUMBER

( )

FAX NUMBER

( )

APPOINTEE NAME

APPOINTEE BUSINESS NAME (If applicable)

APPOINTEE ADDRESS (Number and Street)

(City) (State) (ZIP Code)

TELEPHONE NUMBER

( )

FAX NUMBER

( )

As attorney(s)-in-fact to represent the taxpayer(s) for the following tax or fee matters: [specify type(s) of tax]

Franchise and Income Tax Law

Sales and Use Tax Law

Use Fuel Tax Law

Payroll Tax Law

Beneﬁt Reporting

Other

SPECIFY THE TAx OR FEE YEAR(S) OR PERIOD(S) [IF ESTATE TAx, INDICATE DATE OF DEATH] (for Board of Equalization and Franchise Tax Board purposes)

The attorney(s)-in-fact (or any of them) are authorized, subject to revocation, to receive conﬁdential tax information and to

perform on behalf of the taxpayer(s) the following acts for the tax or fee matters described above: [check the box(es) for the

powers granted]

General Authorization (including all acts described below).

Speciﬁc Authorization (selected acts described below).

To confer and resolve any assessment, claim or collection of a deﬁciency or other tax or fee matter pending before the �

identiﬁed agency and attend any meetings or hearings thereto for the speciﬁed law identiﬁed above. �

To receive, but not to endorse and collect, checks in payment of any refund of taxes, penalties or interest. �

To execute petitions, claims for refund and/or amendments thereto. �

To execute consents extending the statutory period for assessment or determination of taxes. �

To execute closing agreements under section 19441 of the California Revenue and Taxation Code. �

To execute settlement agreements under section 19442 of the California Revenue and Taxation Code. �

(The back of this form must be completed)

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BOE-392 (BACK) REV. 9 (3-11)

To represent the taxpayer for changes to their mailing address for any and all Payroll Tax Law, Beneﬁt Reporting, both

Payroll Tax Law and Beneﬁt Reporting. �

To execute settlement agreements under section 1236 of the California Unemployment Insurance Code. �

To delegate authority or to substitute another representative. �

Other acts (specify):

Franchise Tax Board (FTB) will send you and your ﬁrst representative listed a copy of FTB computer generated notices as they

become available.

Check this box if you do

not want FTB to send copies of available FTB computer generated notices to your ﬁrst

representative listed.

(Note: Not all FTB processing systems are capable of generating representative copies at this time.)

This Power of Attorney revokes all earlier Power(s) of Attorney on ﬁle with the California State Board of Equalization,

the Employment Development Department, or the Franchise Tax Board as identiﬁed above for the same matters and years or

periods covered by this form, except for the following: [specify to whom granted, date and address, or refer to attached copies of

earlier power(s)]

NAME DATE POWER OF ATTORNEY GRANTED

ADDRESS (Number and Street, City, State, ZIP Code)

Unless limited, this Power of Attorney will remain in effect until the ﬁnal resolution of all tax matters speciﬁed herein.

[specify expiration date if limited term]

TIME LIMIT/ExPIRATION DATE (for Board of Equalization and Franchise Tax Board purposes)

Signature of Taxpayer(s)—If a tax matter concerns a joint return, both spouses must sign if joint representation is requested. If you

are a corporate ofﬁcer, partner, guardian, tax matters partner/person, executor, receiver, registered domestic partner, administrator,

or trustee on behalf of the taxpayer, by signing this Power of Attorney you are certifying that you have the authority to execute this

form on behalf of the taxpayer.

IF THIS POWER OF ATTORNEY IS NOT SIGNED AND DATED BY AN AUTHORIZED INDIVIDUAL, IT WILL BE RETURNED AS INVALID.

SIGNATURE

TITLE (If applicable) DATE

PRINT NAME TELEPHONE

( )

SIGNATURE TITLE (If applicable) DATE

PRINT NAME TELEPHONE

( )