Form Oes 190T – Fill Out and Use This PDF

OES-190T (Rev.4-07)

OKLAHOMA EMPLOYMENT SECURITY COMMISSION

POWER OF ATTORNEY – TAX

I, ___________________________________, am the owner or OFFICER with authority to contract for

__________________________________________________________________________________________,

Oklahoma Account #_____________________________, Federal ID #_________________________________.

I hereby appoint:

Name:____________________________________

Address: ____________________________________

City, State, and Zip: ____________________________________

Telephone No.: ____________________________________

Fax No.: ____________________________________

As attorney-in-fact to represent the above-named taxpayer before the Oklahoma Employment Security Commission with respect to all unemployment insurance tax matters and issues arising pursuant to Article III of the Employment Security Act of 1980. This Power of Attorney shall be effective immediately and shall remain in effect until the Oklahoma Employment Security Commission receives notice of its revocation. A notice of a revocation of a Power of Attorney or a notice of change of address must be in a separate writing and mailed to the Oklahoma Employment Security Commission at P.O. Box 52003, Oklahoma City, OK 73152-2003. The attorney- in-fact is authorized to receive all confidential information pertaining to the taxpayer’s unemployment insurance tax account. This Power of Attorney removes all earlier Powers of Attorney previously granted by the taxpayer for unemployment insurance tax purposes.

____________________________________	________________________________________
Date	Signature
	________________________________________
	Printed Name
	________________________________________
	Title

ACKNOWLEDGMENT

State of __________________)

) SS.

County of ________________)

Before me, the undersigned, a notary public in and for this county and state, personally appeared

___________________________ and acknowledged to me that he/she executed the above instrument in his/her

official capacity as the free and voluntary act and deed of himself/herself and the taxpayer.

In witness of this fact, I signed this document and affixed my official seal on

________________________________, ________.

Official Seal with Commission Number And Expiration Date:

_____________________________________________

Notary Public

0190