A-222 — Power of Attorney

Important -- to ensure this form works properly, save it to your computer before completing the form.
Wisconsin Department of Revenue

# Part 1 - Taxpayer Information

Text version of this table

Last name or business name		First name		ID number
Spouse's ID number		Spouse’s first name		Spouse’s ID number
Current address				Daytime phone number ( ) -
City	State	Zip code	Email address (optional)

Appointing a new or additional representative Revoking authority of the representative named below
(Complete Parts 3A or 3B)
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.

Part 3A - Entity or Firm
Entity's legal name
Contact's last name

Text version of this table

Entity’s legal name			Phone number ( ) -
Contact’s last name	Contact’s first name
Email address			Fax number ( ) -
Mailing address			Apt. no.
City		State	Zip code

# Part 3B - Individual

Individual's last name
Email address
Mailing address
City
A-222 (R. 10-21)
Contact's first name
Individual's first name
Phone number
( ) -
Fax number
( ) -
Apt. no.
State Zip code
Phone number
( ) -
Apt. no.
State Zip code
Go to Page 2

Form A-222
Taxpayer Name

# Part 3B - Continued

Individual's last name
Email address
Mailing address
City
Power of Attorney
(Please print or type)
ID Number
Individual's first name
Phone number
( ) -
Apt. no.
State Zip code
If revoking a representative's authority, skip Part 4 and sign and date the form.
Part 4 - Full or Limited Authority (check one)
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.
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.
Period(s) (optional)
Authority
Income or Franchise Taxes
Sales and Use Taxes
Excise Taxes
Property Taxes
Part 5 - Signature of Taxpayer(s)
Authority Period(s) (optional)
Employer Withholding Taxes
Pass-Through Withholding
Taxes
Nontax Debt
Other (describe below)
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.
Signature
Signature
Title Date
Title Date
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.

A-222 — Power of Attorney

# Part 1 - Taxpayer Information

# Part 3B - Individual

# Part 3B - Continued

Tables and rate charts from the source document

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Individual’s last name	Individual’s first name
Email address			Phone number ( ) -
Mailing address			Apt. no.
City		State	Zip code