Government of the District of Columbia
Department of Employment Service
Office of Unemployment Compensation – Tax Division
4058 Minnesota, Avenue, N.E.
WASHINGTON, DC 20019
Phone: (202) 698-7550
Email: essp.info@dc.gov
POWER OF ATTORNEY
Form No.: OUCTAX-1
Name of Legal Entity: _____________________________________________________ Trade Name: _______________________
Federal ID Number: _____________ SUI Number: __________
I, _______________________________________________________________________________________________________ am
Name and Personal Mailing Address of Owner, Officer, or Duly Authorized Representative – Do Not List PO Box
the owner an officer or a duly authorized representative of
___________________________________________________________________________________________________________,
Name and the Location of the Business
and I appoint ________________________________________________________________________________________________
Name and Address of the TPA Appointed
as my agent (attorney-in-fact) to act for me on behalf of the above-named business in any lawful way with respect to the following initialed subjects
with the District of Columbia Department of Employment Services.
PLACE YOUR INITIALS BY THE FUNCTIONS AUTHORIZED THROUGH THE POWER OF ATTORNEY:
________ (1) Unemployment Insurance Benefit Claims and Litigation.
The timely processing of unemployment benefit claims:
(a) Employee separation and wage requests
(b) Benefit appeals; employer charge protests
________ (2) Tax matters.
(a) Employer registrations; account updates
(b) Filing and payment of taxes related to employer liability to the District of Columbia
(c) Tax appeals
THIS POWER OF ATTORNEY IS EFECTIVE BEGINNING ____________ AND WILL EXPIRE ON ______________.
MM/DD/YYYY MM/DD/YYYY
I agree that any third party who receives a copy of this document may act under it. Revocation of the power of attorney is not effective as to a third
party until the third party learns of the revocation. I agree to indemnify the third party for any claims that arise against the third party because of
reliance on this power of attorney. Further, I agree that the power of attorney does not relieve my responsibilities outlined in Title 51 of the District of
Columbia Code.
Signed this ________ day of ______________, ________ _____________________________________________
Day Month Year Signature (Employer)
Declaration of Representative: Representative(s) must complete this section and sign below.
Under penalties of perjury, I declare that:
I am not currently under suspension or disbarment from practice before the Internal Revenue Service (IRS).
I am aware of regulations contained in Treasury Department Circular #230, as amended, concerning the practice of attorneys, certified
public accountants, enrolled agents, enrolled actuaries, and others and the penalties for false or fraudulent statements provided in DC
Official Code 47-4106.
I am authorized to represent in the District of Columbia the taxpayer(s) identified for the tax matter(s) specified herein; and I am one of the
following:
(a) A member in good standing of the bar of the highest court of the jurisdiction shown below.
(b) A Certified Public Accountant duly qualified to practice in the jurisdiction shown below.
(c) An Enrolled Agent under the requirements of the Treasury Department Circular # 230.
(d) A bona fide officer of the taxpayer’s organization.
(e) A full-time employee of the taxpayer, trust, receivership, guardian or estate.
(f) A member of the taxpayer’s immediate family (i.e. spouse, parent, child, brother, or sister).
(g) An actuary enrolled by the Joint Board for the Enrollment of Actuaries (the authority to practice before IRS is limited by
Treasury Department Circular #230).
(h) An unenrolled return preparer under the requirements of Treasury Department Circular #230.
(i) A general partner of a partnership.
(j) Other.
Designation – Inset above letter (a-j)
ADP,LLC, and its subsidiaries and Corporate Cost Control, LLC. To be known as ADP New Hampshire.
PO BOX 1390 LONDONDERRY NH 03053-1390
