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12/17/2013
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12/17/2013
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Marriage License
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• <br /> FORM <br /> Nebraska Department of Power of Attorney <br /> REVENUE 33 <br /> TAXPAYER'S NAME AND ADDRESS <br /> Name of Taxpayer Business Name <br /> TOMMY'S, INC/LA ISLA BAR, INC LA ISLA BAR, INC <br /> a Address(Street or Other Mailing Address) Business Address(Street or Other Mailing Address) <br /> ° 1710 S LOCUST STREET 106 E 3RD STREET <br /> git City State Zip Code City State Zip Code <br /> GRAND ISLAND NE 68801 GRAND ISLAND NE 68801 <br /> °—' Nebraska ID or Social Security Number Federal ID or Social Security Number <br /> 46-0643479 <br /> ATTORNEY-IN-FACT'S NAME AND ADDRESS <br /> (If more than two,see Designation of Attorney-in-Fact in the instructions.) <br /> Name Name <br /> DAVID J. FAIMON <br /> Title or Firm Name Title or Firm Name <br /> CPA/McDERMOTT& MILLER, PC <br /> Address(Street or Other Mailing Address) Address(Street or Other Mailing Address) <br /> 2722 S LOCUST STREET <br /> City State Zip Code City State Zip Code <br /> GRAND ISLAND NE 68801 <br /> Email Address Phone Number Email Address Phone Number <br /> DFAIMON@ MMCPAS.COM 308-382-7850 <br /> The taxpayer appoints the above attorneys-in-fact for purposes of duly authorized representation in any proceedings with the Nebraska <br /> Department of Revenue(Department)with respect to those tax categories,tax matters,and tax periods indicated below: <br /> Tax Category Tax Matter of Representation Tax Period <br /> PROPERTY PERSONAL PROPERTY TAX VALUATION 2013 <br /> & RELATED PENALTIES & INTEREST <br /> The attorneys-in-fact designated on this form have the authority to receive confidential information on behalf of the taxpayer and the <br /> power to perform the following acts with respect to the designated tax matters. Strike through any items which will not be granted. <br /> • Fully represent the taxpayer in any hearing,determination,or appeal. <br /> • Enter into any compromise with the Department. <br /> • Execute waivers, including offers of waivers,of restrictions on assessment or collection of tax deficiencies. <br /> • Execute waivers of notice of disallowance of a claim for credit or refund. <br /> • Execute consents extending the statutory period for issuing a notice of deficiency determination. <br /> • Receive,but not endorse or collect,checks in payment of any refund of taxes,penalties,or interest. <br /> • Receive all notices and other written communications with respect to the taxpayer in proceedings involving the above matters. <br /> If more than one attorney-in-fact is named,enter name of the attorney-in-fact to receive these notices. <br /> • Perform other acts,specifically: <br /> REVOCATION OF PRIOR POWERS OF ATTORNEY <br /> A. ❑ I choose to revoke all prior powers of attorney on file with the Department with respect to the same tax matters,and tax periods <br /> listed above,except the following: <br /> B. ❑ I choose to revoke all powers of attorney on file with the Department. <br /> If signed by a corporate officer,partner,member,LLC manager,or fiduciary on behalf of the taxpayer,I hereby certify that I have the authority to execute <br /> this Power of Attorney on behalf of the taxpayer. <br /> sign ► Si nature Date <br /> here T rinM EDWARpS � " Email Address Ti e,If pl ISLA BAR. INC <br /> Si Date <br /> Print Name Email Address Title,It Applicable <br /> 7-139-1978 Rev.7-2012 Supersedes 7-139-1978 Rev.9-2009 <br />
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