Limited Power of Attorney for Taxes by kjo13673

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									                     LIMITED POWER OF ATTORNEY



I, _______________________________________________whose address is ________


_________________________________________________________________, hereby
appoint ____________________________________, my true and lawful agent and
attorney in fact to act in my name and behalf for the following specific acts:


          1.   To apply for and receive a federal tax identification number.
          2.   To withhold and pay all state and federal unemployment taxes.


This Limited Power of Attorney shall remain in full force and effect until revoked by
either party in writing or my participation in the IndependentChoices Program
ceases.


IN WITNESS WHEREOF, this _________ day of _______________________, 2004.




Program Participant


Witnesses:                                         Address:


________________________________                   ______________________________
                                                   ______________________________


_______________________________                    ______________________________
                                                   ______________________________




                                                                                 Page 1 of 1
DAAS-IC-15
02/2004

								
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