Form CDTFA-392 "Power of Attorney" - California

What Is Form CDTFA-392?

This is a legal form that was released by the California Department of Tax and Fee Administration - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2018;
  • The latest edition provided by the California Department of Tax and Fee Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form CDTFA-392 by clicking the link below or browse more documents and templates provided by the California Department of Tax and Fee Administration.

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Download Form CDTFA-392 "Power of Attorney" - California

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CDTFA-392 (FRONT) REV. 11 (1-18)
STATE OF CALIFORNIA
POWER OF ATTORNEY
CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION
EMPLOYMENT DEVELOPMENT DEPARTMENT
Check below to indicate the appropriate agency. Please note that a separate form must be completed and provided to each agency checked.
CALIFORNIA DEPARTMENT OF
EMPLOYMENT DEVELOPMENT DEPARTMENT
TAX AND FEE ADMINISTRATION
PO BOX 826880 MIC 28
PO BOX 942879
SACRAMENTO CA 94280-0001
SACRAMENTO, CA 94279-0001
1-916-654-7263 • FAX 1-916-654-9211
1-800-400-7115 (TTY:711)
TAXPAYER’S OR FEEPAYER’S NAME
BUSINESS OR CORPORATION NAME
TELEPHONE NUMBER
FAX NUMBER
(
)
(
)
SOCIAL SECURITY NUMBER
FEDERAL EMPLOYER IDENTIFICATION NUMBER
CALIFORNIA SECRETARY OF STATE NUMBER(S)
CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION ACCOUNT/PERMIT(S)
EDD EMPLOYER ACCOUNT NUMBER
MAILING ADDRESS (Number and Street, City, State, ZIP Code)
INDIVIDUAL
PARTNERSHIP
CORPORATION
LIMITED LIABILITY COMPANY
OTHER
As owner, officer, receiver, administrator, or trustee for the taxpayer or feepayer, or as a party to the tax or fee matter
before the:
California Department of Tax and Fee Administration
Employment Development Department
I hereby appoint: [enter below the individual appointee(s) name(s), address(es) (including ZIP code), telephone number(s) and
fax number(s)—do not enter names of accounting or law firms, partnerships, corporations, etc., as the appointee name]
APPOINTEE NAME
APPOINTEE NAME
APPOINTEE BUSINESS NAME (if applicable)
APPOINTEE BUSINESS NAME (if applicable)
APPOINTEE ADDRESS (Number and Street)
APPOINTEE ADDRESS (Number and Street)
(City)
(State)
(ZIP Code)
(City)
(State)
(ZIP Code)
TELEPHONE NUMBER
FAX NUMBER
TELEPHONE NUMBER
FAX NUMBER
(
)
(
)
(
)
(
)
As attorney(s)-in-fact to represent the taxpayer(s) or feepayer(s) for the following tax or fee matters: [specify type(s) of
tax]
Tax and Fee Programs Administered by CDTFA
Benefit Reporting
Payroll Tax Law
Other:
SPECIFY THE TAX OR FEE YEAR(S) OR PERIOD(S)
The attorney(s)-in-fact (or any of them) are authorized, subject to revocation, to receive confidential tax information and
to perform on behalf of the taxpayer(s) the following acts for the tax or fee matters described above: [check the box(es)
for the powers granted]
General Authorization (including all acts described below).
Specific Authorization (selected acts described below).
To confer and resolve any assessment, claim or collection of a deficiency or other tax or fee matter pending before the
identified agency and attend any meetings or hearings thereto for the specified law identified above.
To receive, but not to endorse and collect, checks in payment of any refund of taxes, penalties or interest.
To execute petitions, claims for refund and/or amendments thereto.
To execute consents extending the statutory period for assessment or determination of taxes.
To represent the taxpayer for changes to their mailing address for any and all Payroll Tax Law, Benefit Reporting, both
Payroll Tax Law and Benefit Reporting.
(The back of this form must be completed)
CDTFA-392 (FRONT) REV. 11 (1-18)
STATE OF CALIFORNIA
POWER OF ATTORNEY
CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION
EMPLOYMENT DEVELOPMENT DEPARTMENT
Check below to indicate the appropriate agency. Please note that a separate form must be completed and provided to each agency checked.
CALIFORNIA DEPARTMENT OF
EMPLOYMENT DEVELOPMENT DEPARTMENT
TAX AND FEE ADMINISTRATION
PO BOX 826880 MIC 28
PO BOX 942879
SACRAMENTO CA 94280-0001
SACRAMENTO, CA 94279-0001
1-916-654-7263 • FAX 1-916-654-9211
1-800-400-7115 (TTY:711)
TAXPAYER’S OR FEEPAYER’S NAME
BUSINESS OR CORPORATION NAME
TELEPHONE NUMBER
FAX NUMBER
(
)
(
)
SOCIAL SECURITY NUMBER
FEDERAL EMPLOYER IDENTIFICATION NUMBER
CALIFORNIA SECRETARY OF STATE NUMBER(S)
CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION ACCOUNT/PERMIT(S)
EDD EMPLOYER ACCOUNT NUMBER
MAILING ADDRESS (Number and Street, City, State, ZIP Code)
INDIVIDUAL
PARTNERSHIP
CORPORATION
LIMITED LIABILITY COMPANY
OTHER
As owner, officer, receiver, administrator, or trustee for the taxpayer or feepayer, or as a party to the tax or fee matter
before the:
California Department of Tax and Fee Administration
Employment Development Department
I hereby appoint: [enter below the individual appointee(s) name(s), address(es) (including ZIP code), telephone number(s) and
fax number(s)—do not enter names of accounting or law firms, partnerships, corporations, etc., as the appointee name]
APPOINTEE NAME
APPOINTEE NAME
APPOINTEE BUSINESS NAME (if applicable)
APPOINTEE BUSINESS NAME (if applicable)
APPOINTEE ADDRESS (Number and Street)
APPOINTEE ADDRESS (Number and Street)
(City)
(State)
(ZIP Code)
(City)
(State)
(ZIP Code)
TELEPHONE NUMBER
FAX NUMBER
TELEPHONE NUMBER
FAX NUMBER
(
)
(
)
(
)
(
)
As attorney(s)-in-fact to represent the taxpayer(s) or feepayer(s) for the following tax or fee matters: [specify type(s) of
tax]
Tax and Fee Programs Administered by CDTFA
Benefit Reporting
Payroll Tax Law
Other:
SPECIFY THE TAX OR FEE YEAR(S) OR PERIOD(S)
The attorney(s)-in-fact (or any of them) are authorized, subject to revocation, to receive confidential tax information and
to perform on behalf of the taxpayer(s) the following acts for the tax or fee matters described above: [check the box(es)
for the powers granted]
General Authorization (including all acts described below).
Specific Authorization (selected acts described below).
To confer and resolve any assessment, claim or collection of a deficiency or other tax or fee matter pending before the
identified agency and attend any meetings or hearings thereto for the specified law identified above.
To receive, but not to endorse and collect, checks in payment of any refund of taxes, penalties or interest.
To execute petitions, claims for refund and/or amendments thereto.
To execute consents extending the statutory period for assessment or determination of taxes.
To represent the taxpayer for changes to their mailing address for any and all Payroll Tax Law, Benefit Reporting, both
Payroll Tax Law and Benefit Reporting.
(The back of this form must be completed)
CDTFA-392 (BACK) REV. 11 (1-18)
To execute settlement agreements under section 1236 of the California Unemployment Insurance Code.
To delegate authority or to substitute another representative.
To Other acts (specify):
This Power of Attorney revokes all earlier Power(s) of Attorney on file with the California Department of Tax and Fee
Administration or the Employment Development Department as identified above for the same matters and years or
periods covered by this form, except for the following: [specify to whom granted, date and address, or refer to attached
copies of earlier power(s)]
NAME
DATE POWER OF ATTORNEY GRANTED
ADDRESS (Number and Street, City, State, ZIP Code)
Unless limited, this Power of Attorney will remain in effect until the final resolution of all tax or fee matters specified
herein.
[specify expiration date if limited term]
TIME LIMIT/EXPIRATION DATE (for California Department of Tax and Fee Administration purposes)
Signature of Taxpayer(s) or Feepayer(s)—If a tax or fee matter concerns a joint return, both spouses must sign if joint
representation is requested. If you are a corporate officer, partner, guardian, tax or fee matters partner/person, executor,
receiver, registered domestic partner, administrator, or trustee on behalf of the taxpayer or feepayer, by signing this Power of
Attorney you are certifying that you have the authority to execute this form on behalf of the taxpayer or feepayer.
IF THIS POWER OF ATTORNEY IS NOT SIGNED AND DATED BY AN AUTHORIZED INDIVIDUAL, IT WILL BE RETURNED AS INVALID.
SIGNATURE
TITLE (if applicable)
DATE
PRINT NAME
TELEPHONE
(
)
SIGNATURE
TITLE (if applicable)
DATE
PRINT NAME
TELEPHONE
(
)
CLEAR
PRINT
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