Form REV184r, Revocaon of Power of Aorney
Read the instrucons before compleng this form.
Appointee Revocaon
Taxpayer
Taxpayer Name Social Security Number or ITIN
Street Address or PO Box Minnesota or Federal Employer Idencaon Number (FEIN)
Apt. or Suite Phone Number
City State ZIP Code Email Address
Choose one opon below to revoke Power of Aorney authority on Minnesota Department of Revenue accounts.
OPTION 1 — Revoke Power of Aorney authority for one appointee.
Appointee Name Firm or Company Name
Street Address or PO Box Apt. or Suite
City State ZIP Code
OPTION 2 — Revoke Power of Aorney authority for all appointees at a company.
Firm or Company Name
Street Address or PO Box Apt. or Suite
City State ZIP Code
OPTION 3 — Revoke all Power of Aorney authority for all appointees (Only the taxpayer can remove all authority).
This revocaon is not valid unl it is signed and dated by someone with legal authority to sign agreements on behalf of the taxpayer.
Parent, guardian, conservator, or ocer: I cerfy that I have the legal authority to sign this form.
Send a signed copy of this form to the department:
Mail: Minnesota Department of Revenue, Mail Staon 4123, 600 N. Robert St., St. Paul, MN 55146
Fax: 651-556-5210
Email: MNDOR.POA@state.mn.us
Form REV184r Instrucons
Signature Print Name and Title Date
Signature
Purpose of This Form
By signing this form, you direct the Minnesota Department of Revenue to revoke authority for the appointees listed above. The appointee will
no longer be able to represent the taxpayer or receive their private information.
Appointees can be reinstated using Form REV184i, Individual or Sole Proprietor Power of Attorney or Form REV184b, Business Power of
Attorney.
Your Signature
This revocation 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
information is being shared.
Can a Power of Aorney appointee revoke themselves?
Appointees can withdraw their authority to represent a client by completing this form themselves.
Quesons?
Website: www.revenue.state.mn.us
Email: MNDOR.POA@state.mn.us
Phone: 651-556-3003 or 1-800-657-3909
(Rev. 11/19)
