Fillable Printable BOE-392 - California Power of Attorney Form
Fillable Printable BOE-392 - California Power of Attorney Form
BOE-392 - California Power of Attorney Form
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)
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.
s
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
( )
