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Kansas Department of Revenue Power of Attorney Form

In the case of you wanting to assign another person to handle your tax-related issues in the State of Kansas, the following form has to be completed and submitted.

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_________________________________________________________     ________________________________________________      ____________ ____________ 
                                                                                                                                                                    	
 	_________________________________________________________     ________________________________________________      ____________ ____________ 
                                                                                                                                                                    
 	
KANSAS DEPARTMENT OF REVENUE 

POWER OF ATTORNEY 
	
Retention/revocation of prior Powers of Attorneys. I hereby revoke all earlier powers of attorney on file with the Kansas Department of Revenue for the same tax matters and periods covered by this document. 	
1 	Check this box if you DO NOT wish to revoke a prior power of attorney.  You  must attach a copy of any 
power of attorney you want to remain in effect.

INSTRUCTIONS FOR POWER OF ATTORNEY AUTHORIZATION 	
A power of attorney is a legal document authorizing someone to act as your representative.  You - the taxpayer ­
must complete, sign, and return this form if you wish to grant a power of attorney (POA) to an attorney, accountant, 
agent, tax return preparer, family member, or anyone else to act on your behalf with the Kansas Department of 
Revenue.  You may use this form for any matter affecting any tax administered by the department, including audit 
and collection matters.  This POA will remain in effect until the expiration date, if included under Section 2, or until 
you revoke it, whichever is earlier.  The department will accept copies of this form, including fax copies. 
INSTRUCTIONS 
S	
ECTION 	1.  T	AX P AYE R 	INFORMATION	. 
Individuals .  In the block provided, enter your name, 
SSN, address, and telephone number in the spaces 
provided.  If this POA is for a joint return and your 
spouse is designating the same representative or 
representatives, enter your spouse’s name and Social 
Security number, and your spouse’s address if 
different from your own. 
Businesses.   Enter both the legal name and the DBA 
or trade name, if different.  For example, if the 
business is an individual proprietorship, enter the 
proprietor's name and the name under which business 
is transacted.  (e.g., Joe Smith dba Joe's Diner) . Also 
enter the EIN (federal employer identification number), 
the business address, and telephone number.   
Estates.   Enter the name, title, and address of the 
decedent’s executor/personal representative in the 
taxpayer section. Use the spouse’s section to enter 
the decedent’s name, date of death, and SSN. 
S	
ECTION 	2.  T	AXPAYER GRANT OF 	POWER OF 	ATTORNEY	. 
Representative's name.  For this block, complete all 
the requested information for each representative. If 
the representative is a member of a firm, enter the 
firm’s name too.  If you are designating more than two 
representatives, please complete another form and 
attach it to this form. Mark the second form “additional 
representatives.” 
Type of tax.   For this block, enter the type of tax and 
the tax years or reporting periods for each tax type.  If 
you wish the power of attorney to apply to all periods 
and all tax types administered by the department, 
please enter  "All tax types"  in the block for "Type of 
Tax" and "All tax periods" in the block for "Year(s) or 
Period(s)." If the matter relates to estate, inheritance, 
or succession tax, please enter the date of the 
decedent’s death. 
Authorized acts.   Check all boxes that apply.  Use 
the additional lines to limit, clarify, or otherwise define 
the acts authorized by this POA.  For example, if you 
wish to limit the POA to a specific time period or to 
establish an expiration date, enter that information 
and the dates (month, day, and year) on these lines.  Retention/revocation of prior powers of attorney
. 
Unless otherwise specified, this POA replaces and 
revokes all previous POAs on file with the department. 
If there is an existing POA that you do NOT want to 
revoke, check the box in this section and attach a 
copy of each POA that will remain in effect.  If you wish to revoke an existing POA without 
naming a new representative, attach a copy of the 
previously executed POA.  On the copy of the 
previously executed POA, write “REVOKE” across the 
top of the form, and initial and date it again under your 
signature or signatures already in Section 3. 
S	
ECTION 	3.  S	IGNATURE OF 	TAXP AYER OR 	TAX P AYE RS	. 
You must sign and date the POA.  If a joint return is 
being filed and both husband and wife intend to 
authorize the same person to represent them, both 
spouses must sign the POA unless one spouse has 
authorized the other in writing to sign for both.  You must 
attach a copy of your spouse's written authorization to 
this POA. 
S	
ECTION 	4.  S	IGNATURE OF 	REPRESENTATIVE OR 
REPRESENTATIVES	
. 
Each representative that you name must sign and 
date this form. 
QUESTIONS? 
If you have questions about this form, please visit 
or call our office. 
Taxpayer Assistance Center 

Docking State Office Building, 1	
st Floor 

915 SW  Harrison St. 
 Topeka, KS  66612 

Phone:  (785) 368-8222 

Hearing Impaired TTY:  (785) 296-6461 

The Department of Revenue office hours are 8:00
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