DE 48 Rev. 3 (9-03) (INTERNET)
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POWER OF ATTORNEY DECLARATION
SEE INSTRUCTIONS ON THE BACK OF THIS FORM
I. EMPLOYER/TAXPAYER INFORMATION (please type or print)
California Employer Account Number:
Federal Employer Identification Number (FEIN):
Social Security Number (SSN)/Corporate Identification
Business Name/Doing Business As (DBA):
Business Mailing Address:
Business Telephone No.:
Business FAX No.
Business Location (if different from above):
II. REPRESENTATIVE DESIGNATION
I hereby appoint the following person to represent the employer/taxpayer for specified tax matters arising under
the California Unemployment Insurance Code.
III. AUTHORIZED ACT(S)
If you want to give the representative general authority to perform all acts on
your behalf with regard to your state tax matters.
If you want to give the representative limited authority with regard to your state
From ________ To ________
tax matters, indicate the specific dates and acts you are authorizing.
Other acts: (describe specifically)_________________________________________________________
Subject to revocation, the above representative is authorized to receive confidential information.
IV. SIGNATURE AUTHORIZING POWER OF ATTORNEY
Signature of the employer/taxpayer, owner, officer, receiver, administrator, or trustee for the
Employer/taxpayer – If you are a corporate officer, partner, guardian, tax matters partner/person, executor, receiver,
administrator, or trustee on behalf of the employer/taxpayer, you are certifying that you have the authority to execute
this form on behalf of the employer/taxpayer by signing this Power of Attorney Declaration.
If this Power of Attorney Declaration is not signed and dated, it will be returned as invalid.