Fillable Printable Power of Attorney for Representation - Oregon
Fillable Printable Power of Attorney for Representation - Oregon
Power of Attorney for Representation - Oregon
150-800-005 (Rev. 12-15)
Tax Information Authorization
and
Power of Attorney for Representation
For office use only
Date received
Complete the following, if known (for routing purposes only):
Revenue employee: __________________________________________________
Division/Section: ____________________________________________________
Phone/Fax: _________________________________________________________
Send to: Oregon Department of Revenue
955 Center St NE
Salem OR 97301-2555
• Please print. • Use only blue or black ink. • See additional information on the back.
Address City State ZIP code
Taxpayer name Identifying number (SSN, BIN, FEIN, etc.)
Spouse’s name, if joint return
Spouse’s identifying number (SSN, etc.)
Check only one:
Tax Information Authorization: Checking this box allows the department to disclose your confidential tax information to your
designee. You may designate a person, agency, firm, or organization.
Power of Attorney for Representation: Check this box if you want a person to “represent” you. This means the person may
receive confidential information and may make decisions on your behalf. The person you designate must meet the qualifications
listed on the back of this form.
For All tax years, or Specific tax years: __________________________________________________________________ ,
I hereby appoint the following person as designee or authorized representative:
Mailing address
City
State ZIP code
Name
Phone
Fax
( ) ( )
Signature of taxpayer(s)
• I acknowledge the following provision: Actions taken by an authorized representative are binding, even if the representative is
not an attorney. Proceedings cannot later be declared legally defective because the representative was not an attorney.
• Corporate officers, partners, fiduciaries, or other qualified persons signing on behalf of the taxpayer(s): By signing, I also certify
that I have the authority to execute this form.
•
If a tax matter concerns a joint return, both spouses must sign if joint representation is requested. Taxpayers filing jointly may
authorize separate representatives.
The above named is authorized to receive my confidential tax information and/or represent me before the Oregon Department of Revenue for:
All tax matters, or
Specific tax matters.
Enter tax program name(s): ________________________________________________________________________
Visit www.oregon.gov/dor to complete this form using Revenue Online.
If this tax information authorization or power of attorney form is not signed, it will be returned.
Power of attorney forms submitted with Revenue Online will be signed electronically.
Daytime phone
Note: This authorization form automatically revokes and replaces all earlier tax authorizations and/or all earlier powers of attorney
on file with the Oregon Department of Revenue for the same tax matters and years or periods covered by this form. If you do not
want to revoke a prior authorization, initial here ______.
Attach a copy of any other tax information authorization or power of attorney you want to remain in effect.
( )
Print name Date
Print name Date
Signature
X
Title (if applicable)
Spouse (if joint representation)
X
Representative’s title and Oregon license number or relationship to taxpayer
If out-of-state CPA, sign here attesting you meet the requirements to practice in Oregon (see instructions)
Clear Form
150-800-005 (Rev. 12-15)
Additional information
This form is used for two purposes:
• Tax information disclosure authorization. You authorize
the department to disclose your confidential tax infor-
mation to another person. This person will not receive
original notices we send to you.
• Power of attorney for representation. You authorize
another person to represent you and act on your behalf.
The person must meet the qualifications below. Unless
you specify differently, this person will have full power to
do all things you might do, with as much binding effect,
including, but not limited to: providing information; pre-
paring, signing, executing, filing, and inspecting returns
and reports; and executing statute of limitation extensions
and closing agreements.
This form is effective on the date signed. Authorization termi-
nates when the department receives written revocation notice
or a new form is executed (unless the space pr
ovided on the
front is initialed indicating that prior forms are still valid).
Unless the appointed representative has a fiduciary relation-
ship to the taxpayer (such as personal representative, trustee,
guardian, conservator), original Notices of Deficiency or
Assessment will be mailed to the taxpayer as required by
law. A copy will be provided to the appointed representative
when requested.
For corporations, “taxpayer” as used on this form, must be
the corporation that is subject to Oregon tax. List fiscal years
by year end date.
Qualifications to represent taxpayer(s) before
Department of Revenue
Under Oregon Revised Statute (ORS) 305.230 and Oregon
Administrative Rule (OAR) 150-305.230, a person must meet
one of the following qualifications in order to represent you
before the Department of Revenue.
1. For all tax programs:
a. An adult immediate family member (spouse, parent,
child, or sibling).
b. An attorney qualified to practice law in Oregon.
c. A certified public accountant (CPA) or public accoun-
tant (PA) qualified to practice public accountancy in
Oregon, and their employees.
d. An IRS enrolled agent (EA) qualified to prepare tax
returns in Oregon.
e. A designated employee of the taxpayer.
f. An officer or full-time employee of a corporation (includ-
ing a parent, subsidiary, or other affiliated corporation),
association, or organized group for that entity.
g. A full-time employee of a trust, receivership, guardian-
ship, or estate for that entity.
h. An individual outside the United States if representa-
tion takes place outside the United States.
2. For income tax issues:
a. All those listed in (1); plus
b. A licensed tax consultant (LTC) or licensed tax pre-
parer (LTP) licensed by the Oregon State Board of Tax
Practitioners.
3. For ad valorem property tax issues:
a. All those listed in (1); plus
b. An Oregon licensed real estate broker or a principal real
estate broker; or
c. An Oregon certified, licensed, or registered appraiser; or
d. An authorized agent for designated utilities and com-
panies assessed by the department under ORS 308.505
through 308.665 and ORS 308.805 through 308.820.
4. For forestland and timber tax issues:
a. All those listed in (1), (2), and (3)(b) and (c); plus
b. A consulting forester.
An individual who prepares and either signs your tax return
or who is not required to sign your tax return (by the instruc-
tions or by rule), may represent you during an audit of that
return. That individual may not represent you for any
other purpose unless they meet one of the qualifications
listed above.
Generally, declarations for representation in cases appealed
beyond the Department of Revenue must be in writing to the
Tax Court Magistrate. A person recognized by a Tax Court
Magistrate will be recognized as your representative by the
department.
Tax matters partners and S corporation shareholders. See
OARs 150-305.242(2) and (5) and 150-305.230 for additional
information. Include the partnership or S corporation name
in the taxpayer name area.
Out-of-state attorneys and CPAs
Attorneys may contact the Oregon State Bar for information
on practicing in Oregon. If your out-of-state representative
receives authorization to practice in Oregon, attach proof to
this form.
CPAs may practice in Oregon if they meet the following
substantial equivalency requirements of ORS 673.010:
1. Licensed in another state;
2. Have an accredited baccalaureate degree with at least 150
semester hours of college education;
3. Passed the Uniform CPA exam; and
4. Have a minimum of one year experience.
Have questions? Need help?
General tax information ...................... www.oregon.gov/dor
Salem ............................................................... (503) 378-4988
Toll-free from an Oregon prefix ................1 (800) 356-4222
Asistencia en español:
En Salem o fuera de Oregon ........................(503) 378-4988
Gratis de prefijo de Oregon ......................1 (800) 356-4222
TTY (hearing or speech impaired; machine only):
Salem area or outside Oregon .....................(503) 945-8617
Toll-free from an Oregon prefix ................1 (800) 886-7204
Americans with Disabilities Act (ADA): Call one of the help
numbers above for information in alternative formats.
