Fillable Authorized Representative Declaration (Power of Attorney) (Kallas Restaurant Accounting)

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Authorized Representative Declaration (Power of Attorney) (Kallas Restaurant Accounting)

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Michigan Department of Treasury
Issued under authority of Public Act 122 of 1941.
151 (Rev. 07-19)
Authorized Representative Declaration (Power of Attorney)
INSTRUCTIONS: Use this form to authorize the Michigan Department of Treasury to communicate with a named individual or entity acting
on your behalf. Also use this form to designate a representative to receive copies of correspondence regarding a particular tax dispute
(other than City Income Tax). All information designated as “required” must be supplied for this authorization to be eective.
You may restrict authority in boxes 1-4 to a specic matter (Not required)
Tax Type, Debt or Fee Year(s) or period(s)
PART 1: TAXPAYER OR DEBTOR INFORMATION
Taxpayer’s Name (Required) If a business, include any DBA, trade or
assumed name. If ling joint return, include spouse’s name.
FEIN, ME or TR Number (Required for business taxes)
Taxpayer or Business Address (Required)
Taxpayer’s Social Security Number (Required if
no FEIN, ME, or TR Number listed)
Spouse’s Social Security Number
Taxpayer’s E-mail Address
Daytime Telephone Number (Required) Fax Number
PART 2: REVOCATION OF AUTHORITY
To revoke the authority of your current representative, check the applicable box in this section. Check only ONE box.
I revoke all prior authorizations. I will represent myself.
I revoke prior authorizations in the matter/dispute listed in Part 4 and/or Part 5. I will represent myself.
I revoke prior authorizations in the matter/dispute listed in Part 4 and/or Part 5 and appoint a new representative in Part 3 who is authorized
under Part 4 and/or 5.
PART 3: REPRESENTATIVE APPOINTMENT
Your representative may be an entity or an individual. If you designate an entity you must also provide an individual as a contact. If no start date is
indicated the authorization is eective as of the date this form is signed. If no expiration date is indicated the authorization is eective until revoked.
Authorized Representative’s Name (Required) Contact Name (Required if an entity is named)
Authorized Representative’s Address (Required)
Telephone Number (Required) Fax Number
Authorization Start Date (mm/dd/yyyy) Authorization Expiration Date (mm/dd/yyyy)
Authorized Representative’s E-mail Address
PART 4: TYPE OF AUTHORITY
If you check a box, you authorize your representative to act in that capacity.
1. Receive and inspect condential information (upon request only). (To have your representative receive copies of all future letters and
notices involving a tax dispute [other than City Income Tax], you must complete Part 5.)
2. Make oral or written presentation of fact or argument.
3. Sign returns.
4. Enter into agreements.
5. All of the above.
PART 5: REQUEST COPIES OF LETTERS AND NOTICES REGARDING A TAX DISPUTE (other than City Income Tax)
By checking this box, you are directing Treasury to send a copy of all future notices and letters involving a particular tax dispute to your
representative named in Part 3 under section 8 of the Revenue Act (MCL205.8). This dispute is for year(s) or period(s) __________________ and
Tax (income tax, sales tax, use tax, etc.)_________________________________________________________ (Tax and year(s) or period(s)
are both required if this box is checked.)
PART 6: TAXPAYER OR DEBTOR AUTHORIZATION
By signing this form, I authorize Treasury to communicate with my representative consistent with the authority granted.
Signature (Required) Print Name (Required) Title (Required if a business) Date (Required)
Spouse’s Signature Print Name Title Date (Required if spouse signs)
TREASURY USE ONLY
Division Name Reviewer Initials
Accepted Rejected
Reset Form
Form 151, Page 2
Purpose
Use the Authorized Representative Declaration (Power of
Attorney) (Form 151) to authorize the Michigan Department
of Treasury (Treasury) to communicate with a named
individual or entity acting on your behalf. This form may
also be used to revoke your representative’s authority or to
designate a representative to receive letters and notices
regarding a particular tax dispute.
Required information. If a box includes the word
“Required,” you must provide the information. If a box does
not contain the required information, the form is invalid and
you will be notified by letter.
Part 2: Revoking the authority of a representative.
Complete Part 2 if you want to revoke your representative’s
authority in whole or in part or all prior authorizations. After
you revoke your representative’s authority, you may represent
yourself, or you may appoint a new representative.
Part 3: Appointing an entity as your representative.
If you appoint an entity as your representative, then any
individual within that entity is authorized to act on your
behalf. For example, if you appoint the XYZ Law Firm as
your representative, any attorney or paralegal from that firm
is authorized to act on your behalf. The “Contact Name” is
only to ensure that information sent to the entity is directed
to the individual overseeing your representation. The contact
name is NOT your sole authorized representative. To appoint
an entity, write in the Name and Address box (for example):
XYZ Law Firm
1234 Street
City, State, ZIP Code
Appointing an individual as your representative. If you
appoint a specific individual as your representative, then only
that individual is authorized to act on your behalf. Treasury
will only discuss with or disclose information to that
individual. For example, if a specific attorney at the XYZ
Law Firm is named as your representative, Treasury will not
discuss with or disclose information to any other attorney or
paralegal at the same firm. To appoint an individual, write in
the Name and Address box (for example):
Lynn Lee
XYZ Law Firm
1234 Street
City, State, ZIP Code
Part 4: Type of authority: General or limited. You may
grant your representative general or limited authority to act
on your behalf. The actions that your representative may
take will depend on the boxes that you check in Part 4.
Confidential information (box 1) will only be provided upon
request; Treasury will not automatically send confidential
information to your representative. If you check box 5 in
Part 4, you are granting your representative general authority
to act on your behalf regarding any tax return and any debt.
However, granting your representative general authority does
not give the representative the right to receive future copies
of letters and notices unless Part 5 is also completed.
Part 5: Requesting copies of letters and notices with
respect to a tax dispute.
NOTE: This part does not apply to City Income Tax.
If you complete Part 5, you must identify on the line in Part 5
a single tax matter that is in dispute. The dispute may cover
more than one tax period or year. If you have more than
one dispute with Treasury and want your representative
to receive copies of future notices and letters with respect
to those additional disputes, you must fill out a separate
form for each dispute. Part 5 does not give a representative
authority to act on your behalf. You must give your
representative authority to act on your behalf by checking
one or more boxes in Part 4 if you want your representative
to do more than just receive future notices and letters. Only
one representative can be authorized to receive future letters
and notices regarding a specific tax dispute under Part 5.
Treasury will only send future letters and notices to the
person identified on the most recent form. If you appoint an
entity as your representative, future letters and notices will
be sent to the attention of the first “Contact Name.”
Deceased taxpayer. Do not use this form for a deceased
taxpayer. File a Claim for Refund Due a Deceased Taxpayer
(MI-1310) with a death certificate and/or a letter of authority
(issued by the probate court) for a personal representative.
MAILING OR FAXING INSTRUCTIONS
Individual taxpayers:
Michigan Department of Treasury
Customer Contact Center
Individual Correspondence Section
P.O. Box 30058
Lansing, Ml 48909
Fax: 517-636-4488
When Treasury Collections asks for this form and any
attachments:
Michigan Department of Treasury — Coll
P.O. Box 30149
Lansing, Ml 48909
Fax: 517-272-5562
When a Treasury field office representative asks for this
form, send it as directed by that office.
For all others:
Michigan Department of Treasury
Customer Contact Center
Registration Section
P.O. Box 30778
Lansing, Ml 48909
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Authorized Representative Declaration (Power of Attorney) (Kallas Restaurant Accounting)

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Completed 26 May 2021

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