Kansas Power of Attorney

Power of Attorney
DO-10 Power of Attorney Rev. 1-22
800618

KANSAS DEPARTMENT OF REVENUE
1.

POWER OF ATTORNEY

TAXPAYER INFORMATION.

Include spouse's name if this is for a joint return. If a business, enter both its legal name and its trade or DBA name. Both the person
granting and the person being granted the power of attorney must sign and date this form below in Sections 3 and 4.
Taxpayer's Name (if a business include both legal name and DBA name)
Address
Foreign Address (if applicable)

Taxpayer’s EIN/SSN/PTIN

City
City

State
Province

Country

Zip Code

Zip Code

Area Code & Phone Number

Email Address

Spouse's Name

Spouse’s Social Security Number

Address (if different)
Foreign Address (if applicable)

City
City

State
Province

Country

Zip Code

Zip Code

Area Code & Phone Number

Email Address

2. TAXPAYER GRANT OF POWER OF ATTORNEY.
I hereby appoint the following attorney, accountant, or other representative as my attorney-in-fact:
Representative's name and title (if member of a firm, enter both the representative's name and firm name)
Address
Foreign Address (if applicable)

City
City

EIN/SSN/PTIN
State

Province

Country

Zip Code

Representative's name and title (if member of a firm, enter both the representative's name and firm name)
Address
Foreign Address (if applicable)

City
City

Country

Zip Code

Fax Number

Email Address
EIN/SSN/PTIN

State
Province

Zip Code

Phone Number

Zip Code

Phone Number
Fax Number

Email Address

To represent me before the Kansas Department of Revenue for the following tax matters:
 All Tax Types (if not all list those applicable below)
 All Tax Years (if not all list those applicable below)
Type of Tax (Individual Income, Sales, Withholding, etc.)

Tax Year(s) or Period(s)

AUTHORIZED ACTS.
For the tax types and periods listed, the representative(s) are authorized to (check all applicable boxes):





Receive and inspect my confidential tax information.
Represent me in tax matters before the department.




Sign agreements, consents or other documents on my behalf.
Perform any act that I can perform with respect to the tax
matter listed above.

List any specific additions or deletions to the acts that are otherwise authorized in this power of attorney (see Instructions).

RETENTION/REVOCATION OF PRIOR POWERS OF ATTORNEY.
I hereby revoke all earlier powers of attorney on file with the Kansas Department of Revenue for the same tax matters and periods
covered by this document.

 Check here if you DO NOT wish to revoke a prior power of attorney. List below representatives you want to retain power of attorney.
Representative's name and title (if member of a firm, enter both the representative's name and firm name)

EIN/SSN/PTIN

Representative's name and title (if member of a firm, enter both the representative's name and firm name)

EIN/SSN/PTIN

PLEASE SIGN PAGE 2
DO-10 Rev. 1-22

3.

4.

SIGNATURE OF TAXPAYER(S). If a tax matter concerns a joint return, both husband and wife must sign when joint representation
is requested. When a corporate officer, partner, guardian, executor, receiver, administrator, or trustee signs this section on
behalf of a taxpayer, the signatory also certifies that the signatory is authorized to execute this form on behalf of the taxpayer.
(Signature)

(Printed Name)

(Date)

(Signature)

(Printed Name)

(Date)

(Signature)

(Printed Name)

(Date)

(Signature)

(Printed Name)

(Date)

SIGNATURE OF REPRESENTATIVE(S).

INSTRUCTIONS FOR POWER OF ATTORNEY AUTHORIZATION
A power of attorney is a legal document authorizing someone to act as your representative. You, the taxpayer,
must complete, sign, and return this form if you wish to grant a power of attorney (POA) to an attorney, accountant,
agent, tax return preparer, family member, or anyone else to act on your behalf with the Kansas Department of
Revenue (KDOR). You may use this form for any matter affecting any tax administered by the department, including
audit and collection matters. This POA will remain in effect until the expiration date, if included under Section 2, or
until you revoke it, whichever is earlier. KDOR will accept copies of this form, including fax copies.
SECTION 1. TAXPAYER INFORMATION.
Individuals. In the block provided, enter your name, SSN,
address, telephone number, and email address in the spaces
provided. If this POA is for a joint return and your spouse is
designating the same representative or representatives, enter
your spouse’s name, address (if different from your own),
Social Security number, and your spouse’s email address.
Businesses. Enter both the legal name and the DBA or trade
name, if different. For example, if the business is an individual
proprietorship, enter the proprietor's name and the name
under which business is transacted. (e.g., Joe Smith dba Joe's
Diner). Also enter the EIN (federal employer identification
number), telephone number, business address, and email
address.
Estates. Enter the name, title, address, and email address
of the decedent’s executor/personal representative in the
taxpayer section. Use the spouse’s section to enter the
decedent’s name, date of death, and SSN.

SECTION 2. TAXPAYER GRANT OF POWER OF ATTORNEY.
Representative's name. Complete all the requested
information for each representative. If the representative is a
member of a firm, enter the firm’s name too. If you are
designating more than two representatives, please complete
another form and attach it to this form. Mark the second form
“additional representatives.”
Type of tax. If you wish the power of attorney to apply to all
periods and all tax types administered by KDOR, please
check the box(es) for "All tax types" and "All tax periods". If for
a specific tax type and/or tax year enter the type of tax and
the tax years or reporting periods for each tax type. If the
matter relates to estate, inheritance, or succession tax, please
enter the date of the decedent’s death.
Authorized acts. Check all boxes that apply. Use the
additional lines to limit, clarify, or otherwise define the acts
authorized by this POA. For example, if you wish to limit the
POA to a specific time period or to establish an expiration
date, enter that information and the dates (month, day, and
year) on these lines.

Retention/revocation of prior powers of attorney. Unless
otherwise specified, this POA replaces and revokes all
previous POAs on file with the department. If there is an
existing POA that you do NOT want to revoke, check the
box in this section and enter the representative’s name and
EIN/SSN/PTIN in the space provided.
If you wish to revoke an existing POA without naming a
new representative, attach a copy of the previously executed
POA. On the copy of the previously executed POA, write
“REVOKE” across the top of the form, and initial and date it
again under your signature or signatures already in Section 3.

SECTION 3. SIGNATURE OF TAXPAYER(S).
You must sign and date the POA. If a joint return is
being filed and both husband and wife intend to authorize
the same person to represent them, both spouses must sign
the POA unless one spouse has authorized the other in
writing to sign for both. You must attach a copy of your
spouse's written authorization to this POA.

SECTION 4. SIGNATURE OF REPRESENTATIVE(S).
Each representative that you name must sign and date
this form.
TAXPAYER ASSISTANCE
If you have questions about this form, please visit or call
our office.
Taxpayer Assistance Center
Scott State Office Building
120 SE 10th St.
PO Box 3506
Topeka, KS 66625-3506
Phone: 785-368-8222
The Department of Revenue office hours are 8 a.m. to
4:45 p.m., Monday through Friday.
Additional copies of this form are available from our
website at: ksrevenue.gov
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