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The Massachusetts tax power of attorney is a legal document used by the grantor to authorize the attorney-in-fact to act on his/her behalf in his/her tax related matters.
Power of Attorney and
Declaration of Representative
See separate instructions. Please print or type.
Part 1. Power of Attorney
Name of taxpayer(s)Social Security number(s)
Number and street, including apartment number or rural routeFederal Identification number
Hereby appoint(s) the following individual(s) as attorney(s)-in-fact to represent the taxpayer(s) before any office of the Massachusetts Department of
Revenue for the following tax matter(s) (specify the type(s) of tax and year(s) or period(s) (date of death if estate tax)):
Type of tax (individual, corporate, etc.)Year(s) or period(s) (date of death if estate tax)
The attorney(s)-in-fact (or any of them) are authorized, subject to any limitations set forth below or to revocation, to receive confidential information and to
perform any and all acts that the principal(s) can perform with respect to the above specified tax matters, such as the authority to sign any agreements,
consents or other documents.The authority does not include the power to substitute another representative (unless specifically added below) or the power
to receive refund checks.
List any specific additions or deletions to the acts otherwise authorized in this power of attorney:
Originals of notices and other written communications go to the taxpayer(s). Send copies of all notices and all other written communications addressed
to the taxpayer(s) in proceedings involving the above tax matters to:
1the appointee first named above, or
2(name of another appointee designated above)
This power of attorney revokes all earlier powers of attorney on file with the Department of Revenue for the same tax matters and years or periods cov-
ered by this power of attorney, except the following (specify to whom granted, date and address including Zip code or attach copies of earlier powers):
Signature of or for taxpayer(s). If signed by acorporate officer, partner, or fiduciary onbehalf of the taxpayer, I certify that I have theauthority to execute
this power of attorney on behalf of the taxpayer.
SignatureTitle (if applicable)Date
If signing for a taxpayer who is not an individual, type or print your name
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