Fillable Printable Limited Power of Attorney Example - Wyoming
Fillable Printable Limited Power of Attorney Example - Wyoming
Limited Power of Attorney Example - Wyoming
DAVE FREUDENTHAL, Governor
E
DMUND J. SCHMIDT, Director
State of Wyoming
DEPARTMENT OF REVENUE
122 West 25th Street, 2-West, Cheyenne, Wyoming 82002-0110
Telephone: (307) 777-7961 ○ Web:http://revenue.state.wy.us ○ E-mail:dor@wy.gov
Administration Fax (307)777-7722 ○ Ad Valorem Division Fax (307)777-7722 ○ Excise Division Fax (307)777-3632 ○ Mineral Division Fax (307)777-7849 ○ Liquor Division Fax (307)777-6255
Effective 09/23/04
ETS Form 150
Excise Tax Division
Limited Power of Attorney
Sales/Use Tax License Number:
Revenue Identification Number:
Business’/Owner’s/Taxpayer’s Name:
Mailing Address:
TO WHOM IT MAY CONCERN: I/We have appointed
as our agent to represent the above mentioned taxpayer before the Wyoming Excise Tax
Department for the following excise tax matters until further notice:
Tax Type (Sales, Use, Estate,
Cigarette, etc.)
Document Requested (Tax returns - specify
form #, written determinations, notices, etc.)
Year(s) or
Period(s)
I declare under penalty of perjury that I have the authority to sign this limited power of attorney
for the above mentioned taxpayer:
Authorized by: Title:
(Individual Business – Owner; Corporation – Major Officer;
Partnership – Partner; LLC or LLP – Member or Manager)
Phone Number: Date:
The foregoing document was acknowledged before me by
this day of , 20 .
Witness my hand and official seal,
(Notary Public). My commission expires .
Return signed original to: Wyoming Department of Revenue For questions, please call:
Excise Tax Division, Herschler Bldg.
122 W. 25
th
St., 2
nd
Floor West
Cheyenne, WY 82002-0110
307-777-5200
DAVE FREUDENTHAL, Governor
EDMUND J. SCHMIDT, Director
State of Wyoming
DEPARTMENT OF REVENUE
122 West 25th Street, 2-West, Cheyenne, Wyoming 82002-0110
Telephone:(307) 777-7961 ? Web:http://revenue.state.wy.us ? E-mail:dor@wy.gov
Administration Fax (307)777-7722 ? Ad Valorem Division Fax (307)777-7722 ? Excise Division Fax (307)777-3632 ? Mineral Division Fax (307)777-7849 ? Liquor Division Fax (307)777-6255
Revised 03/22/05
Excise Tax Division
Limited Power of Attorney Instruction Sheet
What is a Limited Power of Attorney form? The Excise Tax Division’s Limited Power of Attorney form
allows taxpayers to authorize someone else, be it attorney, CPA or a new bookkeeper, access to the
taxpayer’s information.
Who must fill one out? The taxpayer fills out the form, and designates who may access the taxpayer’s
records. This is common when the taxpayer wants his/her attorney or CPA to have access to the
taxpayer’s Wyoming sales, use, cigarette or estate tax information.
Where does the Excise Tax Division get its authority for this requirement? The Excise Tax Division is
statutorily prohibited from releasing information without the taxpayer’s permission. The relevant statutes
are W.S. 39-11-102 and W.S. 39-15-102(e).
What is the cost associated with getting the requested records? Per WY Dept of Rev Rules, Chap 1, Sec.
4(a), reproduction fees are structured as follows:
(i) $0.50 per page for the first ten pages;
(ii) $0.15 per page for each additional page over ten pages;
(iii) If certification of a document is requested, there shall be an additional charge of $3.00 per
document;
(iv) Notwithstanding the rates in paragraphs (i), (ii) and (iii), a minimum fee of $10.00 per
request.
How long does it take to get the requested information? The Excise Tax Division needs a minimum of
twenty-four (24) hours lead time to process the request and pull the records. Extensive record requests
may take additional time.
Why was my Limited Power of Attorney form rejected? All applicable areas must be completed, the form
must be notarized, and the original must be submitted to the Excise Tax Division. Copies or facsimiles
are not acceptable.
Why didn’t I get the information I requested? Either you forgot to include payment for the reproduction
fees, or the information requested did not match the boundaries listed on the Limited Power of Attorney
Form. Information released to the designated party is limited to exactly what was listed on the form. If
you requested sales tax returns from June 2000 through July of 2001, but the form authorized only sales
tax returns from January of 2003 through January 2005, your request can not be completed. Contact the
taxpayer and have him/her complete a new limited power of attorney form.
What must I do if the taxpayer changes bookkeepers, or wants to add another person to the list of those
authorized to request the taxpayer’s records? The taxpayer must complete and return a new limited
power of attorney form before that person is allowed access to the taxpayer’s records.
