POA
rev. 09/2012
ALABAMA DEPARTMENT OF LABOR
UNEMPLOYMENT COMPENSATION DIVISION
EXPERIENCE RATING SECTION, ROOM 4215
MONTGOMERY, AL 36131
PHONE: (334) 242-8888/FAX: (334) 242-2068
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
THAT _____________________________________________ ACCOUNT NO.______________________,
___________________________________________FEDERAL ID NO._____________________________a ,
(Corporation, partnership, individual, etc.)
having its principle office at ________________________________________________________, does hereby
constitute and appoint: ____________________________________________________
____________________________________________________
____________________________________________________
Representative’s Contact Name: ___________________________ Telephone: __________________
its true and lawful attorney in fact with full power and authority to represent the said_____________________,
before the Alabama Unemployment Compensation Agency until further notice in the following matter(s), to wit:
(Check appropriate box)
---- [ The filling of reports, payment of contributions, Cost Statements (quarterly), ] TAX
(Limited) Tax Rate Notices (annually), and any legal documents, i.e. assess
ments, garnishments, etc.,
obtaining other account information as is permissible, (employer reporting data, tax rate
information and liability dates).
---- [ Requests for separation, 1st notice of payment of benefits for charge purposes, ] BENEFITS
(Limited) employer’s protest of benefit claims and information relative thereto.
---- [ As described above in the first and second blocks. ] TAX AND BENEFITS
(Unlimited)
--- [ The filing of quarterly reports and payment of contributions only. ] TAX REPORTS ONLY
(Limited)
This authorization cancels and supersedes all prior authorizations associated with the above action checked.
IN WITNESS WHEREOF, the said______________________________________ has caused this instrument to
be duly attested by the signature of its duly qualified officer this day of , .
By: _______________________________________
Duly Qualified Officer
[NOTARY SEAL] _______________________________________
Title
Notary Public
ADP, LLC, and its subsidiaries and Corporate Cost Control, LLC., known as ADP NH.
