Prototype- Tennessee Department of Labor & Workforce Development Declaration of Representative

Tennessee Department of Labor & Workforce Development Declaration of Representative

For questions, please contact Morning Sun Financial Services at 1-844-450-5444
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Tennessee Department of Labor & Workforce Development Declaration of Representative

For questions, please contact Morning Sun Financial Services at 1-844-450-5444
Declaration of Representative

This verifies that Morning Sun Financial Services (Representative) is authorized to represent the Employer
Representative
Employer Legal Name

First NameLast Name
Employer Email
example@example.com
Was the TN Employer Account Number applied for?
Employer's Tennessee Employer Account Number
This authorization supersedes all similar authorizations. This form also authorizes the TDLWD to, in accordance with applicable law, release to the Representative any documentation relating to the Employer's account that it could release to the Employer.
Employer Legal Name

First NameLast Name
Signatures

I understand and accept that my electronic signature will be as valid as a handwritten signature and considered original to the extent allowed by applicable law. Please see the Consumer Consent Disclosure at https://www.jotform.com/consumer-consent-disclosure/
HIDE- Employer Legal Name

First NameLast Name
Employer Signature
Date of Signature

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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Tennessee Department of Labor & Workforce Development Declaration of Representative