Free Michigan 151 Template in PDF

PART 1: TAXPAYER INFORMATION

Enter the taxpayer’s name, address, telephone number, fax number, and e-mail address (if applicable). If the taxpayer is a business operatingunderanothername,entertheDBA,tradeorassumedname. Enter the Social Security number(s), federal employer identification number (FEIN) or other account number, whichever applies. Also enter the UC employer number if this power of attorney applies to any state unemployment matters. If spouses are designating the same representative, enter the spouse’s name, address (if different) and Social Security number.

PART 2: REPRESENTATIVE INFORMATION AND AUTHORIZATION DATES

You must submit a separate form for each representative. Enter the authorized representative’s telephone number, fax number, and e-mail address (if applicable). If your representative is not an individual, designate a contact person. Indicate the beginning and ending dates of authorization.

PART 3: TYPE OF AUTHORIZATION

Check the GeneralAuthorization box to allow your representative to act on your behalf to do all of the following: (1) inspect and receive confidential information, (2) represent you and make oral or written presentations of act and/or argument, (3) sign returns,

(4)enter into agreements, and (5) receive all (includes forms, billings, and payment notices. This authorization applies to all tax/non-tax matters and for all years or periods.

You may restrict your representative’s authorization to act on your behalf by checking the Limited Authorization box, and checking the appropriate boxes in Section A and/or B. To limit the authorization for specific tax matters, check the appropriate “Only as Specified Below” boxes, and indicate the type of tax, type of form, and years/periods for which you are granting authorization in the space provided.

Check this box if your representative is authorized to:

1.Inspect or receive confidential information

2.Represent you and make oral or written presentation of fact or argument.

3.Sign tax returns.

4.Enter into agreements (such as payment plans).

5.Receive mail.

PART 4: CHANGE IN POWER OF ATTORNEY REPRESENTATION OR REVOCATION

Unless otherwise specified, this Power of Attorney Authorization replaces or revokes any previous power of attorney authorizations on file with the Michigan Department of Treasury or the Bureau of Worker’s & Unemployment Compensation for the same tax matters identified on this form.

You must identify any previous authorizations that are to remain in effect, and attach a copy of the authorizations to this form when filed.

PART 5: TAXPAYER SIGNATURE

You and your spouse, if a joint return, must sign and date the form.

FILING

Except as noted below, mail this form to the Registration Section. Treasury will forward your form to BW&UC.

Customer Contact Center

Registration Section

Michigan Department of Treasury

P.O. Box 30477

Lansing, MI 48909-7977

If the Michigan Accounts Receivable Collection System (MARCS) has requested you to file this form, mail your completed form and any attachments to:

MARCS

P.O. Box 30158

Lansing, MI 48909-7658

If a district office representative has requested you to file this form, mail it to that representative.

If the Treasury Collection Division has requested you to file this form, mail it to:

Collection Division

Michigan Department of Treasury

P.O. Box 30199

Lansing, MI 48909

If BW&UC has asked you to file this form, mail it to:

BW&UC Tax Office

P.O. Box 8068

Royal Oak, MI 48068-8068

Or fax to: 313-456-2130 (for BW&UC only)

If you are an individual taxpayer (not representing a business), mail this form to:

Customer Contact Center Individual Correspondence Section Michigan Department of Treasury Lansing, MI 48922