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Reinsurance Intermediary Power of Attorney (Nonresident Individual)

Reinsurance Intermediary Power of Attorney (Nonresident Individual)

 

INSTRUCTIONS: CONNECTICUT NON-RESIDENT INDIVIDUAL REINSURANCE INTERMEDIARY POWER OF ATTORNEY

 

 

To appoint the Insurance Commissioner of Connecticut with the power of attorney in any action or proceeding against you as a non-resident conducting individual reinsurance business in Connecticut, use the form discussed in this article. This document can be obtained from the website maintained by the government of the state of Connecticut.

 

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 1: On the first blank line, enter your name.

 

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 2: On the second blank line, enter the city or town where you live.

 

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 3: On the third blank line, enter the state in which you live.

 

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 4: On the fourth blank line, enter your name.

 

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 5: On the fifth blank line, enter your name.

 

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 6: On the sixth blank line, enter the date on which you are completing this form.

 

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 7: On the seventh blank line, enter the month during which you are completing this form.

 

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 8: On the eighth blank line, enter the last two digits of the year in which you are completing this form.

 

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 9: On the ninth blank line, enter your signature.

 

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 10: On the tenth blank line, print your name.

 

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 11: The form must then be signed by a notary public or a commissioner of the Superior Court in your state. On the first three blank lines, they will enter the day, month and year of the date on which you appeared before them.

 

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 12: On the next blank line, the notary public or commissioner will enter their state.

 

Connecticut Non-Resident Individual Reinsurance Intermediary Power Of Attorney Step 13: On the next blank line, the notary public or commissioner will enter your name. They will then enter their signature and the date on which their commission expires.

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Form 285B Disclosure Authorization

Form 285B Disclosure Authorization

 

INSTRUCTIONS: ARIZONA DISCLOSURE AUTHORIZATION FORM (Form 285B)

 

 

To authorize another person to receive confidential tax forms relating to tax payments in Arizona without giving that person power of attorney to represent you, you may use a form 285B. This document can be obtained from the website of the Arizona Department of Revenue.

 

Arizona Disclosure Authorization Form 285B Step 1: Section 1 requires information about the taxpayer. Enter your name, that of your spouse if applicable, your present street address, city, town or post office, state, zip code, and daytime phone number with area code.

 

Arizona Disclosure Authorization Form 285B Step 2: Section 1 also requires you to enter any of the following applicable information: your Social Security number, your spouse's Social Security number, your employer identification number, and/or your Arizona transaction privilege tax license number.

 

Arizona Disclosure Authorization Form 285B Step 3: Section 2 requires you to give information for up to two appointees. Enter the first appointee's name, address (if different from yours), city, town or post office, state, zip code, daytime telephone number, and their Social Security number or other identifying number. Enter the name of the type of identifying number you have entered.

 

Arizona Disclosure Authorization Form 285B Step 4: Enter all the same information for a second appointee if you wish to authorize a second person in this capacity.

 

Arizona Disclosure Authorization Form 285B Step 5: Section 3 concerns the type of tax information your appointees are authorized to receive documentation concerning. The first category is income tax. Enter the years or periods for which your appointees are eligible to receive this information, and check the box next to any or all of the six types of returns they are authorized to receive.

 

Arizona Disclosure Authorization Form 285B Step 6: The second category is transaction privilege and use tax. Enter the years or periods for which your appointees are eligible to receive this information and check the box next to any or all of the seven types of returns they are authorized to receive.

 

Arizona Disclosure Authorization Form 285B Step 7: The third category is withholding tax. Check the box next to this if applicable. The last category is "other." You must specify the type of taxes and the returns which can be released.

 

Arizona Disclosure Authorization Form 285B Step 8: Sign and print your name and enter the date in section 5. 

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