UITL-18 (R 08/2008)
Colorado Department of Labor and Employment, Unemployment Insurance Operations, P.O. Box 8789, Denver, CO 80201-8789
303-318-9100 (Denver-metro area) or 1-800-480-8299 (outside Denver-metro area)
POWER OF ATTORNEY
Please print or type the information. Instructions for completing this form are provided on the reverse.
Employer Account Number (Required)
Acceptance of New Power of Attorney
Effective Date of Acceptance _____________________________
The acceptance of the new power of attorney is for:
All unemployment insurance (UI) information
UI tax-related information only
UI benefit-claim-related information only
Your acceptance of a new power of attorney supersedes any existing power of attorney previously approved by UI Operations.
Name and Complete Address of Power of Attorney
Provide your preferred mailing address for UI correspondence. All UI correspondence will be mailed to the address you provide below unless you
elect to have UI benefit-claim-related information sent to a different address.
Complete Mailing Address
If you prefer to have UI benefit-claim-related information sent to a different address, complete this section. If not, all UI correspondence will be
mailed to the address you provided above. Complete only if the address is different from the address you provided above.
Complete Mailing Address (for UI benefit-claim-related correspondence)
Power of Attorney Representative Name (Print Name)
Power of Attorney Representative Signature (Required)
I hereby grant permission to the above-named entity or individual to act on my behalf for the purpose stated on this document.
Employer Official (Print Name)
Signature of Employer Official (Required)
To be completed by notary public to authenticate employe