POWER OF ATTORNEY (POA)/AUTHORIZATION OF AGENT
South Dakota Department of Labor and Regulation
Unemployment Insurance Division
PO Box 4730, Aberdeen, SD 57402 Phone 605.626.2312 Fax 605.626.3347 www.sdjobs.org
Effective Date _________________________________
That the Undersigned Employer ___________________________________________________________
Employer’s Mailing Address ___________________________________________________________
___________________________________________________________
A ____ Corporation ____ Partnership ____ Individual
Federal ID Number ________________________________________
SD UI Account Number ____________________________________ OR ____ Applied For
Does Hereby Appoint POA ___________________________________________________________
Along with its divisions and subsidiaries the true and lawful attorneys-in-fact of the undersigned, until further written notice, to represent
the undersigned before any and all government bodies, agencies or instrumentalities, regarding the following matters:
POWER OF ATTORNEY/ADDRESS AUTHORIZATION
(MARK ALL THAT APPLY)
____ TAX Power of Attorney
Indicate below the address that should receive all Tax information including rate notices, quarterly reports, benefit charges,
delinquent notices, debit/credit notices.
If left blank the address will default to the employer’s mailing address listed above.
__________________________________________________
__________________________________________________
__________________________________________________
____ BENEFITS Power of Attorney
Indicate below the address that should receive all Benefit information including claim notices and appeals.
If left blank the address will default to the employer’s mailing address listed above
.
__________________________________________________
__________________________________________________
__________________________________________________
____ LIMITED Power of Attorney
Indicating Limited Power of Attorney denotes that the appointed POA listed above files the quarterly reports for the employer.
Limited Power of Attorney also allows access to employer payroll information and tax rates.
There is no address change with Limited Power of Attorney.
Each of said attorneys-in-fact shall have the power to act with or without the others and the power and authority to perform, in the name
of and on behalf of the undersigned, every act necessary to carry out the subject matter hereof as fully as the undersigned could do.
The undersigned hereby ratifies and approves the acts of said attorneys-in-fact.
This authorization supersedes and revokes any prior power of attorney or authorization from the undersigned relating to the subject
matter hereof.
____________________________________ _____________________________________
Employer’s Signature (Authorized Officer) Employer’s Name and Title (type/print)
____________________________________ _____________________________________
Date Telephone Number
ADP,LLC, and its subsidiaries and Corporate Cost Control, LLC.
The parties may be addressed collectively as ADP New Hampshire.
