Fillable Form REV184i, Individual or Sole Proprietor Power of (Minnesota Department of Revenue)

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Form REV184i, Individual or Sole Proprietor Power of (Minnesota Department of Revenue)

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Form REV184i, Individual or Sole Proprietor Power of Aorney
Read instrucons before compleng this form. To grant authority for a business, complete Form REV184b, Business Power of Aorney.
Addional
Authority Granted
Primary Appointee Taxpayer
Signature
Powers
Taxpayer Name Social Security Number or ITIN
Street Address or PO Box Minnesota or Federal Employer Idencaon Number (FEIN)(Sole Proprietors)
Apt. or Suite Phone Number Fax Number
City State ZIP Code Email Address
Name of Appointee Aorney Number, Accountant Number, or PTIN
Street Address or PO Box Phone Number
Apt. or Suite Fax Number
City State ZIP Code Email Address
If appoinng more than one person, enter on page 2 of this form.
I appoint the person above, and anyone included on the aached list, to access my informaon and represent me before the Minnesota
Department of Revenue. This authority does not cover powers listed in the Addional Powers secon below, unless indicated.
Check the box for Limited Authority or Full Authority.
Limited Authority
The appointee is authorized to act on my behalf, but only for the following:
Type of Tax (Such as Income, Estate,
Property Tax Refund, Withholding) or Debt Issue
Years or Periods
(If le blank, applies to all)
Full Authority
The appointee is
authorized to act on
my behalf for all of my
tax and debt issues for
all years or periods.
Authority Expiraon Date:
Add the following powers to the appointee’s limited or full authority (Check any that apply):
Communicate with the department by email Add addional appointees (Primary Appointee only)
Sign returns and other tax forms Receive all mail except refunds (see instrucons) (Primary Appointee only)
Extend statute of limitaons to assess tax Authorize the department to release my return informaon to third pares
Execute agreements Act on my behalf if I become incapacitated or incompetent (Durable POA)
This Power of Aorney is not valid unl it is signed and dated by the taxpayer.
Parent, Guardian, Conservator: I cerfy that I have the legal authority to sign this form.
Signature Date Address, If Dierent from Taxpayer
Print Name and Title, If Applicable Phone Number City State ZIP Code
Send a signed copy of this form to the department:
Mail: Minnesota Department of Revenue, Mail Staon 4123, 600 N. Robert St., St. Paul, MN 55146
Fax: 651-556-5210
Email: MNDOR.POA@state.mn.us
(Rev. 11/19)
Form REV184i, Page 2 — Addional Appointees
Name of Taxpayer SSN, ITIN, MN ID, or FEIN
Include any addional appointees below. Addional appointees only have authority over maers chosen in the Authority Granted
and Addional Powers secons on page 1.
Name of Appointee Aorney Number, Accountant Number, or PTIN
Street Address or PO Box Phone Number
Apt. or Suite Fax Number
City State ZIP Code Email Address
Name of Appointee Aorney Number, Accountant Number, or PTIN
Street Address or PO Box Phone Number
Apt. or Suite Fax Number
City State ZIP Code Email Address
Name of Appointee Aorney Number, Accountant Number, or PTIN
Street Address or PO Box Phone Number
Apt. or Suite Fax Number
City State ZIP Code Email Address
Name of Appointee Aorney Number, Accountant Number, or PTIN
Street Address or PO Box Phone Number
Apt. or Suite Fax Number
City State ZIP Code Email Address
Name of Appointee Aorney Number, Accountant Number, or PTIN
Street Address or PO Box Phone Number
Apt. or Suite Fax Number
City State ZIP Code Email Address
Aach addional copies of this page, as needed.
Form REV184i Instrucons
What is a Power of Aorney (POA)?
A power of attorney (POA) is a legal document that grants an attorney, accountant, agent, tax return preparer, or other person authority to
access your account information and represent you before the Minnesota Department of Revenue.
Use of Informaon
The information you enter on this form may be private or nonpublic under state law. We use it to allow your appointee to access your ac-
count and take actions on your behalf. We may share it with other government entities for tax administration if allowed by law. You are not
required to provide the information requested, however, we are unable to process the appointment unless the form is complete.
How do I complete this form?
Taxpayer
Step 1
Enter the individual taxpayer’s name and contact information. Submit two separate forms if authorizing the same person for you (REV184i)
and your business (REV184b). Submit only one form for you and your spouse.
Step 2
Enter the appropriate identication number: Social Security number (SSN), Individual Taxpayer ID number (ITIN), Federal Employer ID
number (FEIN), or Minnesota Tax ID number.
Deceased Individuals and Estates: Enter the decedent’s name and SSN or ITIN in the Taxpayer section. Include the contact information for
the decedent’s executor or personal representative.
Sole Proprietors: If you are authorizing an appointee for both individual and business tax issues, enter your SSN or ITIN
and your FEIN or Minnesota Tax ID number.
Primary Appointee
Eligibility: Your appointee must be eligible to represent you with the department.
You may not appoint:
• A person barred or suspended from practice as an attorney or accountant
• A person barred or suspended from practice before the Internal Revenue Service (IRS)
• A current employee of the department
• A former department employee within one year of leaving the department
For details, go to www.revenue.state.mn.us and enter Preparer Enforcement in the Search box.
Step 3
An appointee is a person selected to represent you before the department. Enter the appointee’s name and contact information. You may
have more than one appointee, but only the primary appointee can be selected to receive mailed correspondence from the department.
For additional appointees, complete page 2 of Form REV184i. Include additional pages, if needed.
Note: You are responsible for keeping your appointees informed of changes to your account.
Authority Granted
Step 4
Choose whether to grant the appointee full authority or to limit authority to specic issues.
Limited Authority allows the appointee to act on specic tax or debt issues.
• By tax type or issue
• By year or ling period is optional. If no year is provided, authority applies to all periods.
Full Authority allows your appointee to act on your behalf for your tax and debt issues.
Choose an expiration date for the POA if applicable. To have the POA end on a specic date, enter the month, day, and year (enter as MM/
DD/YY). If no date is provided, the POA and additional powers will remain in eect until removed.
Connued
Form REV184i Instrucons, cont.
Addional Powers
Step 5
Choose additional powers to give the appointee.
• Communicate by email: Allows your appointee to communicate with the department by email.
Note: Transmit return information via email at your own risk. Email is not secure; the department is not liable for damages caused by inter-
ception of emails.
• Sign returns and other forms: This does not authorize the appointee to endorse or negotiate any checks or other payments issued by the
department.
• Add additional appointees: Allows a primary appointee to authorize additional appointees.
Note: The appointee may only grant authority over tax types or issues you authorized in the Authority Granted section.
• Execute agreements: Allows the appointee to enter into contracts and other binding agreements on behalf of the taxpayer.
• Authorize disclosure to third parties: Allows your appointee to authorize the department to share return information with people outside
the department. Appointees may discuss your account with people they employ or supervise, even if this box is not checked.
• Receive all mail except refunds: Authorizes the department to mail letters, legal notices, and tax information directly to the primary ap-
pointee only. Any refunds or letters relating to refunds will be sent directly to you. If you are only granting authority for specic years or
periods, this option is not available. All mail will go directly to you.
Note: You may still receive copies of some mail from the department in certain circumstances.
This power is eective only for the tax types or issues granted to the primary appointee.
Mail will go to the most recently designated person, replacing designations from a prior POA.
• Durable POA: Allows this POA to remain in eect if you become incapacitated or incompetent. Consult an attorney if you need more
information about this authority.
Signature
Step 6
Sign, print your name, and date the form.
This POA is not valid until it is signed and dated by someone with legal authority to sign it. For most people, this is the taxpayer whose infor-
mation is being shared.
If granting authority for a joint return, only one spouse needs to sign. Parents or legal guardians must sign for minors. For legal guardians,
conservators, personal representatives, and others signing on behalf of a taxpayer, we require documents and a photo ID to conrm your legal
authority.
We reserve the right to request additional information as needed.
Deceased Individuals and Estates: The decedent’s executor or personal representative must sign, date, and enter their title in the Signature
section.
Step 7
Send the form to the department using only one of the following:
• Mail: Minnesota Department of Revenue, Mail Station 4123, 600 N. Robert St., St. Paul, MN 55146
• Fax: to 651-556-5210
• Email: MNDOR.POA@state.mn.us
How do I revoke an appointee?
To revoke an appointee, you or the appointee must send the department a signed and dated statement terminating the appointee’s authority or
a completed Form REV184r, Revocation of Power of Attorney.
E-Services Account
No POA form is necessary to access a taxpayer’s e-Services account, but the appointee must request Third-Party access through e-Services.
Go to our website and enter Third Party Access in the Search box.
Quesons?
Website: www.revenue.state.mn.us
Email: MNDOR.POA@state.mn.us
Phone: 651-556-3003 or 1-800-657-3909
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Form REV184i, Individual or Sole Proprietor Power of (Minnesota Department of Revenue)

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Completed 29 July 2020

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