OES-190B (Rev.4-07)
OKLAHOMA EMPLOYMENT SECURITY COMMISSION
POWER O
F ATTORNEY – BENEFITS
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 benefit claims and issues arising pursuant to Article II 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 unemployment benefit claims relating to
the above-named taxpayer. This Power of Attorney removes all earlier Powers of Attorney previously granted by
the taxpayer for unemployment benefit claim purposes.
____________________________________ ________________________________________
Date
S
ignature
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____________________________________
P
rinted Name
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____________________________________
T
itle
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
ADP, LLC, and its subsidiaries and Corporate Cost Control, LLC.
The parties may be addressed collectively as ADP-NH.
LONDONDERRY NH 03053-1390
