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Wyoming Department of Revenue Power of Attorney Form

In the State of Wyoming, a resident who hired another individual to handle her/his taxes must complete this form. May it be an accountant or an attorney, the appointed individual must be furnished with a copy of this form. Download

Extracted Text for Proper Search

DAVE 	FREUDENTHAL	, Governor	 	
EDMUND 	J. SCHMIDT	, Director 	 	
State of Wyoming 	
D	EPARTMENT OF 	R	EVENUE	 	
 	 	
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  menti	oned  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 determin	ations, notices, etc.)  	
Year(s) or 
Period(s) 	
    
    
    
    
 
I declare under penalty of perjury that I have th	e authority to sign this limited power of attorney 	
for the above mentioned taxpayer:  
 
Authorized by:                          	 Title:         	 	
  (Individual Business c Owner; Corporation c Major Officer; 	Partnership c Partner; LLC or LLP c 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	 	
D	EPARTMENT OF 	R	EVENUE	 	
 	 	
122 West 25th Street, 2	-We	st, Cheyenne, Wyoming 82002	-011	0 	
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	 	
E	xcise T	ax D	ivision  	
L	im	ited Pow	er of A	ttorney 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, u	se, 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 statu	tes 	
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 eac	h 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  ta	ke  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 re	jected?	 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  t	he 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  sal	es  tax  returns  from  June  2000  through  July  of  2001,  but  the  form  authorized  only  sales 	
tax  returns  fro	m  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	 chang	es 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 a	llowed access to the taxpayer’s records.
Next: Wyoming Durable Financial Power of Attorney Form Previous: Washington Purchase and Sale Agreement Form
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