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    56 views6 pages

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    of 6
    FAX To: E-Services Enrollment From: Aaron Justice Fax: (866) 936-0507 Date: 01/24/2023 Pages: - induding cover sheet Attach the following documents to this FAX cover sheet and fax to the number above. Reporting Agent Authorization FL Unemployment Limited Power of Attomey 86635315 rom 8655 Reporting Agent Authorization | (OMB No. 1545-1058 (Rev. Octobe 2018) Pione Ronree Seven” > Information about Form 8655 and its inatructions is at www-irs.gov/FOrmBSSS. Taxpayer = 1a Name of taxpayer fas distingushed trom Wade name) 2 Employer entiation aumber (iN) Rodriguez Insurance ol 0825547 ‘Trade nama, Hany - 4 It you are a seasonal employer, check bore Q 3 Address (number, street, and room or suite no.) ~ - ‘5 Other identification number (optional), 2218 S Chickasaw Trl City or town, state, and ZiP code. Orlando FL 32625 © Contact person 7 Daytime telephone nuiber ‘ Faxnumber Aaron Justice 407 576-1673 Reporting Agent Name enter company name or name of BusTress) 10 Employer identification number (EN) PayCycle, Inc. 94 3345425 11 Address (number, See, and room oF steno) 6884 Sierra Center Pkwy Gy ortown, Sate, and ZP cove Reno, NV 89511 72 Contact person 8. Daylime telephone number "14 Fax number Jason Shipp 888-927-7478 800 536-1261 Authorization of Reporting Agent to Sign and File Returns (Caution: See Authorization Agreement) ‘15. Incioate the tax retum() tobe signed and ed. Fr quarter returs, use “VYYYINM® fom. "MM" is tho last month of the quater for which the euthorzation begs (lor example, “201808" for third quarter of 2018). For annual tus, use “YYYY" format fo inccatethe yar for which the authorization begins. 940 2023941 2022/03 gyopR_n/a_—gat-PR_n/a_ gan-SS_n/a_ gag. _n/a saspa_n/a = 944202345 n/a 142 n/a CTA n/a Authorization of Reporting Agent to Make Deposits and Payments (Caution: See Authorization Agreement) 16 Indicate the tax returns) for which the reporing ager is authorized to make deposts a payments. Use the “YYYYIMMT format fo ta the month which the ‘axberzation begins or sxampl, "2018/08" for August 2018), 940 2023/01 gg 2023/01 gag _nv/a 944 2023/01 4s _n/a m0 _nfa tou n/a 1042, _n/a 1120 n/a ct n/a 90. _n/a 990-1 _n/a Duplicate Notices to Reporting Agents 17 Check here to request the IRS to issue to the reporting agent duplicate Copies of notices and correspondence regarding retume fled and cepoets orpayments made by thereporingagent. eB Disclosure Authorization for Forms Series W-2, 1089, and/or 3921/3022 ‘182 The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to asst In responding to certain IRS notices relating to the Form W-2 series information retums. This author is effective for calendar year forms beginning 2023 1b The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to carn TRS ‘emioes retating to the Form 1088 series information retums. This author is fective for calendar year forms beginning 2023, © The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain TRS notices relating to the Forms 3821 and 3922. This authority is effective for calendar year forms beginning ‘State or Local Authorization (Caution: See Authorization Agreement) a 10 __ Check hereto authonze the reporting agent to sign and fle stat or local ratums relate to the authorization granted on ne 16 andlor ine 16) ‘Authorization Agreement 7 | understand that th agreement doe no reve we, a8 the taxpayer, ofthe reaponsblly {0 ensure that all tax ature are fled and thal ll dopou and ‘peymarta are made end that | may enrol nthe Electronic Federal Tax eyment System (EFVPO) to view Gepoute ond payments made on my betwl® te 18 Completed, te reporing ager nared above autho 10 sgn and fle th roku inated, bepning win te Roar er yer eiouee fay ela oes ce ie coreited, re paring ager raed above auhorized to make depoute and paymorta taghning wi the pated leas Wy autoreabon gates rohalne Steerer train’ trues ye ebay of apring ner am aur ef dale atwrwan conde! wx rina foe poring Aer {elting tothe authorty garted on ie 16 andlor tne 16, ncusing dacioaures rogues Yo process Form Bos6, Daclosre sinerty ls efecto upen ignanse ef” {21 recap ot Form 8055 The authoty granted en Far BESS ll reve ary Power ot Atoney or 2648 cx oration katoreauon om 33) whee | certty Ihave the autronty to execute thes form and authorize haciowure of ctherwive :onfidental information on beh of the taxpayer - Si Here » Or AZ ) Owner » OL.AY JA023 Signature of taxpayer Tite Date For Privacy Act and Paperwork Reduction Act Notice, ve Intructions, at Wa 10RNTT For 8655 fev 102078 86635315, Ferm 8655 (ev. 10-2018) Instructions What's New Fax number The fx number or Form 855i change a 8552147523 Wien iting Farms ARS nase snd no mare ards lone ra coe ‘varemaion W possible, pans son ares Srey tom jour compose Ptoad ot an ax machine Updated nection foes 16 and 16 The nsructons fo nes 5 and ‘been tared and now appear a te lowe rane Prose vas {he SYVVNMNE format meando tne MIMO eae Former ine 17a removed. The authorization agreeron athe bottom of te ‘omprovdes the dconire athorty preousycovaresy me ti Increasing of author. The instncions with regard to ‘ereaing decreasing uty hive boc Clatid See Atty Granted Termination and Revoetion. The stuctons have ben updated to

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