Fillable AUTHORIZATION THAT T (ADP)

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AUTHORIZATION THAT T (ADP)

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(CORPORAT ION, PARTNERSH IP, I NDIVIDUAL)
(COMPANY NAME AS SHOWN ON FEIN REGISTRATION)
AUTHORIZATION
KNOW ALL MEN BY THESE PRESENTS:
THAT T
HE UNDERSIGNED, ____________________________________________________________ ,
a _____________________________ Federal Employer Identification No. ________________________________ ,
having its principal office at _________________________________________________________________ , does
hereby constitute and appoint ADP, LLC, and its subsidiaries and Corporate Cost Control, LLC, the true and lawful
attorneys-in-fact of the undersigned, until further written notice, to represent the undersigned before any and all
government bodies, agencies or instrumentalities, in all matters affecting unemployment insurance taxes including,
without limitation, all claim, contributions and experience ratings and the signing of any and all documents relating
thereto. The parties, as agent, may be addressed collectively as ADP New Hampshire.
Each of said attorneys-in-fact shall have the power to act with or without the others and the power and
authority to perform, in the name and on behalf of the undersigned, every act necessary to carry out the subject
matter hereof as fully as the undersigned could do. The undersigned hereby ratifies and approves the acts of said
attorneys-in-fact.
This A
uthorization supersedes and revokes any prior power of attorney or authorization from the
undersigned relating to the subject matter hereof.
IN WITNESS WHEREOF, the undersigned has duly executed and delivered this Authorization
this ____________________ day of _______________________________ 20 _________.
_____________________________________________________
Name of Company (type or print)
_____________________________________________________
Signature (Authorized Officer)
_____________________________________________________
Name and Title (type or print)
STATE: ___________
SUI ID: ______________________
ATTEST:
____________________________
UC 6018WV (11-14) ©2014 ADP LLC
West Virginia
NOTARIZATION AND
YOUR CORPORATE SEAL
ARE REQUIRED BY STATE REGULATION.
THIS MESSAGE WILL NOT PRINT.
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CORPORATE SEAL:
Not Incorporated
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AUTHORIZATION THAT T (ADP)

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Completed 8 February 2021

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