FAX

To: E-Services Enrollment From: Richard Horne

Fax: (866) 936-0507 Date: 05/20/2024

Pages: - including cover sheet

Attach the following documents to this FAX cover sheet and fax to the number above.

[ ] Reporting Agent Authorization 2024

[ ] FL Unemployment Limited Power of Attorney

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 DR-835
Florida Department of Revenue R. 10/11
POWER OF ATTORNEY TC
and Declaration of Representative Rule 12-6.0015
Florida Administrative Code
Effective 01/12

See Instructions for additional information

PART I - POWER OF ATTORNEY
Section 1. Taxpayer Information. Taxpayer(s) must sign and date this form on Page 2, Part I, Section 8.
Taxpayer name(s) and address(es) Federal ID no(s). (SSN*, FEIN, etc.) Florida Tax Registration Number(s)
(Business Part. No., Sales Tax No., R.T. Acct No., etc.)
sureshotsids.com 46-2085705 0032586
3516 Clifden Dr Contact person Telephone number (850-577-4632
)
Tallahassee FL 32309 Richard Horne Fax number ( )
The Taxpayer(s) hereby appoint(s) the following representative(s) as attorney(s)-in-fact:
Section 2. Representative(s). Each representative must be listed individually, and must sign and date this form on Page 2, Part II.
Name and address (include name of firm if applicable) Telephone number ((888)927-7478
)
PayCycle, Inc.
6888 Sierra Center Pkwy Fax number ( )
Reno, NV 89511
E-mail address: Cell phone number ( )
Name and address (include name of firm if applicable) Telephone number ( )

Fax number ( )

E-mail address: Cell phone number ( )

Name and address (include name of firm if applicable) Telephone number ( )

Fax number ( )

E-mail address: Cell phone number ( )

To represent the taxpayer(s) before the Florida Department of Revenue in the following tax matters:
Section 3. Tax Matters. Do not complete this section if completing Section 4.
Type of Tax (Corporate, Sales, Reemployment, formerly Unemployment, etc.) Year(s) / Period(s) Tax Matter(s) (Tax Audits, Protests, Refunds, etc.)

Section 4. To Appoint a Reemployment Tax (formerly Unemployment Tax) Agent Only. Do not complete Sections 3 and 6 if
completing Section 4.
By completing this section, an employer (taxpayer) appoints a representative to act as its Florida reemployment tax agent before the Florida
Department of Revenue on a continuing basis and to receive confidential information with respect to mailings, filings, and other tax matters related to
the Florida reemployment assistance program law. All other sections of this form (except Sections 3 and 6) must also be completed.
Do not complete Section 4 unless you wish to appoint a reemployment tax agent on a continuing basis.
Agent name Jason Shipp Agent number (required) A0003276
Firm name PayCycle, Inc. Federal I.D. No. (required) 94-3345425

Address (if different from above)

6888 Sierra Center Pkwy Reno, NV 89511 Telephone number ( )
(888)927-7478

Mail Type: See Instructions for explanations. Check one box only. 1 (Primary) 2 (Reporting) 3 (Rate) 4 (Claim)
Section 5. Acts Authorized
The representative(s) are authorized to receive and inspect confidential tax information and to perform any and all acts that I (we) can perform with
respect to the tax matters described in Section 3 and Section 4 (for example, the authority to sign any agreements, consents, or other documents).
Except as otherwise provided, the authority specifically includes the power to execute waivers of restrictions on assessment or collection of deficiencies
in tax, to execute consents extending the statutory period for assessment or claims for refund of taxes, and to execute closing agreements under
section 213.21, Florida Statutes. This authority does not include the power to endorse or cash warrants, or the power to sign certain returns.
If you want to authorize a representative named in Section 2 to receive (but not to endorse or cash) refund warrants, write the name of the
representative on this line and check the box .......................➧
List any specific limitations or deletions to the acts otherwise authorized in the Power of Attorney.
DO NOT SEND MAIL TO THE AGENT.
 DR-835
R. 10/11
Florida Tax Registration Number: 0032586 Page 2

Taxpayer Name(s): Federal Identification Number: 46-2085705

• Taxpayer(s) must complete Page 1 of this Power of Attorney or it will not be processed.
Section 6. Notices and Communication. Do not complete Section 6 if completing Section 4.
• Notices and other written communications will be sent to the first representative listed in Part I, Section 2, unless the taxpayer selects one of
the options below. Receipt by either the representative or the taxpayer will be considered receipt by both.
a. If you want notices and communications sent to both you and your representative, check this box............................➧

b. If you want notices or communications sent to you and not your representative, check this box.................................➧

Certain computer-generated notices and other written communications cannot be issued in duplicate due to current system constraints. Therefore, we
will send these communications to only the taxpayer at his or her tax registration address.
Section 7. Retention / Nonrevocation of Prior Power(s) of Attorney.
The filing of this Power of Attorney will not revoke earlier Power(s) of Attorney on file with the Florida Department of Revenue,
even for the same tax matters and years or periods covered by this document. If you want to revoke a prior Power of
Attorney, check this box......................................................................................................................................................➧
You must attach a copy of any Power of Attorney you wish to revoke.
Section 8. Signature of Taxpayer(s).
If a tax matter concerns a joint return, both husband and wife must sign if joint representation is requested. If signed by a corporate officer,
partner, member/managing member, guardian, tax matters partner/person, executor, receiver, administrator, trustee, or fiduciary on behalf of the
taxpayer, I declare under penalties of perjury that I have the authority to execute this form on behalf of the taxpayer.
Under penalties of perjury, I (we) declare that I (we) have read the foregoing document, and the facts stated in it are true.
If this Power of Attorney is not signed and dated, it will be returned.

Owner
Signature Date Title (if applicable)

RICHARD HORNE
Print Name

Signature Date Title (if applicable)

Print Name

PART II - DECLARATION OF REPRESENTATIVE

Under penalties of perjury, I declare that:
• I am familiar with the mandatory standards of conduct governing representation before the Department of Revenue, including Rules 12-6.006
and 28-106.107 of the Florida Administrative Code, as amended.
• I am familiar with the law and facts related to this matter and am qualified to represent the taxpayer(s) in this matter.
• I am authorized to represent the taxpayer(s) identified in Part I for the tax matter(s) specified therein, and to receive and inspect confidential
taxpayer information.
• I am one of the following:
a. Attorney - a member in good standing of the bar of the highest court of the jurisdiction shown below.
b. Certified Public Accountant - duly qualified to practice as a certified public accountant in the jurisdiction shown below.
c. Enrolled Agent - enrolled as an agent pursuant to the requirements of Treasury Department Circular Number 230.
d. Former Department of Revenue Employee. As a representative, I cannot accept representation in a matter upon which I had direct
involvement while I was a public employee.
e. Reemployment Tax Agent authorized in Section 4 of this form.
f. Other Qualified Representative
• I have read the foregoing Declaration of Representative and the facts stated in it are true.

Designation - Insert Jurisdiction (State) and

Letter from Above (a-f) Enrollment Card No. (if any) Signature Date

e 05/20/24