The Georgia Department of Labor (Georgia DOL) Power of Attorney is the form an employer signs to appoint an agent to represent it before the agency in matters affecting State Unemployment Insurance Taxes. It is used by an employer that has a GA DOL account number and wants another person to act for it on claims, tax contributions and experience ratings. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the form is published by the Georgia DOL among its documents.
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What is Power of Attorney – Georgia?
The Power of Attorney is a one-page Georgia Department of Labor form by which an employer appoints a named agent as its true and lawful agent, with full authority to represent the employer before the Georgia DOL in all matters affecting State Unemployment Insurance Taxes.
The text lists what those matters include, without limitation: all claims, tax contributions and experience ratings. The appointment runs until further notice, so the form sets no end date.
Completing it produces a signed authorization for the agent. The form also states that it supersedes and revokes any earlier power of attorney from the same employer on the same subject. The person signing for the employer warrants that he or she is authorized to execute it.
The form ends with a request that all forms about unemployment taxes be mailed to a new address of record shown below that line.
It is an employer document. The Georgia DOL documents page lists other, separate forms, such as DOL-5111, Authorization and Release for Disclosure of Unemployment Insurance Information/Records, which individuals use to release their unemployment records. This Power of Attorney does not do that: it covers the employer's State Unemployment Insurance Tax matters.
Who needs to file Power of Attorney – Georgia?
An employer with a GA DOL account number that wants another person to represent it before the Georgia Department of Labor on State Unemployment Insurance Tax matters completes this form. The employer is the party named on the form, and the agent it appoints is the person who gains authority to act.
The form is signed on behalf of the employer by an individual who warrants that he or she is authorized to execute it. That signer enters his or her printed name and title under the employer's name.
An employer that previously gave a power of attorney for the same subject should know that this form supersedes and revokes the earlier authorization.
The wording limits the appointment to matters affecting State Unemployment Insurance Taxes, including claims, tax contributions and experience ratings. The form does not describe any other use.
When to file Power of Attorney – Georgia
Complete the form when the employer decides to appoint an agent to deal with the Georgia DOL on State Unemployment Insurance Tax matters. The form prints no filing deadline.
The appointment lasts until further notice, so the employer does not renew it on a schedule printed on the form. If the employer later names a different agent, a new power of attorney supersedes and revokes the prior authorization relating to the same subject matter.
The form also asks that unemployment tax forms be mailed to the new address of record indicated on it, so it is a natural moment to confirm that address.
How to fill out Power of Attorney – Georgia
Enter the employer's name and account number
In the first line after "THAT," write the employer's name, then enter the employer's GA DOL Account No.
Enter the principal office address
Next to "having its principal office at," write the employer's complete principal office address.
Name the appointed agent
After "hereby appoints," write the name of the person or firm that will act as the employer's agent.
Repeat the employer's name
In the blank after "represent the said," write the employer's name again so the representation before the Georgia Department of Labor is tied to the correct employer.
Read the revocation and authority statements
The form states that it supersedes and revokes any prior power of attorney from the employer on this subject and that the signer is authorized to execute it. Confirm both are true before signing.
Enter the execution date
Complete "this ___ day of ___ 20__" with the day, the month and the last digits of the year.
Complete the signature block
Enter the employer's name on the first line, then the authorized person's signature after "By:," the printed or typed name, and the title.
Enter the new address of record
Under the request that unemployment tax forms be mailed to the new ADDRESS OF RECORD, enter the address where the Georgia DOL should send them.
Review, sign and download the PDF
Check each blank, then download or print the completed PDF from FillingPDF and sign it as required before delivering it to the Georgia DOL.
How to submit Power of Attorney – Georgia
The form itself names no mailing address, fax number, portal or appointment process. It is published among the forms on the Georgia DOL documents page at https://dol.georgia.gov/documents, and the PDF is available at the official URL for this form.
Before sending it anywhere, make sure it is signed and dated and that the GA DOL account number, the agent's name and the address of record are entered. Contact the Georgia Department of Labor to confirm where it should be delivered for your account.
FillingPDF lets you fill out and download the PDF; submission follows the agency's channels.
Common mistakes to avoid
- Leaving the GA DOL Account No. blank, so the form does not identify which employer account the appointment covers.
- Having someone sign who is not authorized to execute the power of attorney for the employer; the signer warrants that authority.
- Skipping the date line: the day, month and year in "this ___ day of ___ 20__" are all part of the execution.
- Omitting the signer's printed name or title under the signature line.
- Forgetting the address of record at the end, although the form asks that unemployment tax forms be mailed there.
- Assuming the form covers matters beyond State Unemployment Insurance Taxes; the wording is limited to that subject, including claims, tax contributions and experience ratings.
- Creating a new appointment without realizing it revokes any earlier power of attorney from the same employer on this subject.
Frequently asked questions
What is the Georgia DOL power of attorney form for?
It lets an employer appoint an agent to represent it before the Georgia Department of Labor in all matters affecting State Unemployment Insurance Taxes, including claims, tax contributions and experience ratings. The appointment lasts until further notice.
Who signs the Georgia DOL Power of Attorney?
A person authorized to act for the employer signs on the employer's behalf, entering his or her signature, printed name and title. The form states that the signer warrants being authorized to execute it.
Does this power of attorney expire?
The form says the appointment is until further notice and prints no expiration date. A later power of attorney from the same employer on the same subject supersedes and revokes the earlier one.
Can I use this form for a power of attorney for an individual's unemployment claim?
No. This form is an employer's authorization for State Unemployment Insurance Tax matters. The Georgia DOL lists a separate form, DOL-5111, which individuals may use to authorize release of their unemployment records.
Do I need the GA DOL account number to complete it?
Yes, the form has a line for the employer's GA DOL Account No. next to the employer's name, along with the principal office address. Enter the number for the account the appointment covers.
Where do I send the Georgia DOL power of attorney?
The form prints no address, fax number or portal. It is published on the Georgia DOL documents page, so contact the Georgia Department of Labor to confirm how to deliver it for your account.
Can I fill out the power of attorney online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is independent of the Georgia DOL and does not submit the form; delivery follows the agency's own channels.
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