Employment Power of Attorney

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Employment Power of Attorney

A Power of Attorney is a legal document that gives someone you trust the legal authority to act for you in the financial, property, or legal matters you choose. The Power of Attorney is frequently used to help in the event of your illness or disability or in legal transactions where you cannot be present to sign necessary legal documents.

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THE PRINCIPAL

Full Name:

Address:

City:

State:

Zip:

AGENT

Full Name:

Address:

City:

State:

Zip:

Would you like to add a second Agent?

Yes No

ALTERNATE AGENT

If you think your agent might not be available at any future time, you may name a second person as an alternate agent. Your alternate agent will be called if your agent is unwilling or unable to serve.

Would you like to include an alternate agent?

Yes No

POWERS TO BE GRANTED

TAX
The filling of reports , payment of contributions, Cost Statements (quarterly), (Limited) Tax Rate Notices (annually), and any legal documents, i.e. assessments, garnishments, etc., or obtaining other account information as is permissible, (employer reporting data, tax rate information and liability dates).

Yes No

BENEFITS
Requests for separation, 1st notice of payment of benefits for charge purposes, (Limited) employer�s protest of benefit claims and information relative thereto.

Yes No

TAX AND BENEFITS
As described above in the first and second blocks. (Unlimited)

Yes No

TAX REPORTS ONLY
The filing of quarterly reports and payment of contributions only. (Limited)

Yes No

Specify your own powers

Yes No

DURABLE OR NON-DURABLE

Answering Yes will make this a Durable power of attorney; answering No will make it Non-Durable
A Durable power of attorney continues to be effective even when the principal becomes incapacitated.
A Non-durable power of attorney terminates upon the principal's incapacity or death.

Do you want this Power of Attorney to be effective even if the Principal becomes incapacitated?

Yes No

Please specify the end date of the Power of Attorney:

SIGNING AND WITNESSESS

Would you like to have the document signed in front of a Notary Public?

No Yes

How many witnesses would you like to sign the document?

None One Two

Agreement Signing Date:

Use the area below to enter any other details that you would like:
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