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T office Taxpayer name State ZIP code Social security or federal identification number Address City, town or post office State ZIP code State ZIP code State ZIP code hereby appoints: Power of Attorney name Telephone number Address City, town or post office Power of Attorney name Telephone number Address City, town or post office as attorney(s)-in-fact to represent the taxpayer(s) before the office of the State of Rhode island, Division of Taxation, for the following.

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