EXAMPLE:

I hereby appoint the following representative(s) and firm, as attorney(s)-in-fact: to represent me, the taxpayer regarding matters pertaining to my IRS - Federal Tax filings, State Tax filings, along with matters surrounding FICA Refund Requests, in a limited capacity.

I authorize my representative(s) to receive and inspect my confidential tax information and to perform on my behalf, with respect to the tax matters described, which would be for preparing my documents, filing my documents and receiving correspondence(s) on my behalf. With respect to any tax withholdings matters and/or FICA refund requests, I acknowledge that this may also involve contacting my current or former employers.

I authorize my representative(s) to contact my current or former employers by mail, phone, fax, and/or email; and to perform the following acts in accordance with providing competent, diligent, and ethical services to me the client, which includes maintaining open communication, keeping me informed about my case, and acting in my best interest. Key standards of care include maintaining confidentiality, providing clear information on strategy and fees, and using reasonable and timely professional judgment. 

I acknowledge that this Power of Attorney and Declaration of Representative shall stay in effect until I revoke and withdraw all power and authority granted under that power of attorney. That I acknowledge that my notice to revoke and withdrawal must be in writing (that verbal revocation is not legally binding) and should contain specific information to ensure clarity and legal validity; and that exercising my right to revoke this power of attorney does not excuse any or remove my legal obligation to pay the firm and/or designated representative noted for the services provided and described in the signed retainer agreement. 

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