Mississippi Tax Power Of Attorney Form 21 002 13

Information you will need

• Taxpayer FEIN
• Other Representative
• Taxpayer Name and Address
• Taxpayer Social Security Number
• Spouse Social Security Number
• Representative Name and Address
• Representative Area Code
• Representative Phone Number
• Representative Fax
• Representative Fax Number
• Tax Type
• Account Number
• Tax Period
• Specific Deletions
• Sepcific Additions
• Prior POA Revocation
• Print Name
• Title of Executing Party
• Taxpayer Phone Number
• Signature Date
• Taxpayer Fax Number
• Designation Letter
• State Issuing License
• State License Number

…and 1 more field in the PDF.

Completed by the agent and the employee.

The form includes 1 signature line.