North Carolina Tax Power Of Attorney Form GEN 58

Information you will need

• z Gen58 print
• z Gen58 clear
• Taxpayer Name and Address
• Taxpayer FEIN (If Applicable)
• Taxpayer Telephone Number
• Taxpayer SSN
• Authorized Acts
• Other
• Type of Tax
• Tax Year or Period
• Taxpayer Name
• Taxpayer Signing Date
• Taxpayer Title
• Designation
• Jurisdiction or Enrollment Card Number
• Representative Signing Date
• Representative Name and Address
• Representative Telephone Number
• Representative Fax Number
• Retain Prior POA
• E Business Center Account

Completed by the agent and the employee.