A-222 — Power of Attorney

# preamble

A-222 (R. 10-21) Wisconsin Department of Revenue Form A-222

# Part 1 - Taxpayer Information

Spouse's last name Spouse's first name Last name or business name First name City Current address ID number Spouse's ID number Daytime phone number ( ) - Email address (optional)State Zip code Part 2 - Representative(s) Describe action (check one) Appointing a new or additional representative Revoking authority of the representative named below (Complete Parts 3A or 3B) Phone number ( ) - Fax number ( ) - Entity's legal name Contact's last name Apt. no. Zip codeStateCity Mailing address Contact's first name Email address Part 3 - Representative is an Entity or Individual (check one) Check here if you want to grant authority to an entire entity or firm and complete Part 3A ONLY. Check here if you want to grant authority to a specific individual(s) and complete Part 3B ONLY. Phone number ( ) - Individual's last name Individual's first name Email address Apt. no. Zip codeStateCity Mailing address

Part 3B - Individual

# Part 3A - Entity or Firm

Power of Attorney (Please print or type)

Form A-222 Page 2 of 2 Taxpayer Name ID Number Part 4 - Full or Limited Authority (check one) Part 5 - Signature of Taxpayer(s) I understand that the execution of this Power of Attorney does not relieve me of personal responsibility for reporting and paying taxes correctly and timely, or from the penalties, fees, or interest for failure to do so, all as provided for under Wisconsin tax law. I understand a photocopy, faxed copy, and/or electronic copy of this form has the same authority as the signed original. If signed by a corporate officer, general partner, managing member, or fiduciary on behalf of the taxpayer, I certify that I have the authority to execute this Power of Attorney on behalf of the taxpayer. Note: All notices that are automatically generated by the department's computer system (e.g. Notice of Amount Due or Notice of Refund/Offset) will be sent only to the taxpayer. Representatives may access copies of most notices through My Tax Account, if the taxpayer authorizes online access to the representative. If the representative does not have access through My Tax Account, they must request copies from the department employee they are working with, or request copies of taxpayer records at https://www.revenue. wi.gov/Pages/FAQS/ise-request.aspx . Signature Title Date Signature Title Date Authority Income or Franchise Taxes Period(s) (optional)Authority Employer Withholding Taxes Pass-Through Withholding Taxes Nontax Debt Other (describe below) Sales and Use Taxes Excise Taxes Property Taxes Period(s) (optional) I grant limited authority to the representative(s) - (check only items below for which you are granting authority.) The representative(s) named above has authority to perform any act, with respect to the items checked below, that the taxpayer(s) can and may perform, including the authority to receive confidential Wisconsin tax information. I grant full authority to the representative(s) - The representative(s) named above has full authority to perform any act with respect to matters before the department that the taxpayer(s) can and may perform, including receiving confidential Wisconsin tax information. Note: If granting full authority, do not check any boxes below. If revoking a representative's authority, skip Part 4 and sign and date the form.

# Part 3B - Continued

Phone number ( ) - Zip code Individual's last name Individual's first name Email address Mailing address City Apt. no. State Power of Attorney (Please print or type)