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Nebraska Tax Power of Attorney Form

The Nebraska 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.

Nebraska Tax Power of Attorney Form
Nebraska Tax Power of Attorney Form
Name of Taxpayer
Address (Street or Other Mailing Address)
City
Nebraska ID or Social Security Number
Zip Code
State
Business Name
Business Address (Street or Other Mailing Address)
City
Federal ID or Social Security Number
Zip Code
State
Name
Title or Firm Name
Name
Title or Firm Name
Zip Code
City
Email Address Phone Number Email Address Phone Number
State
Address (Street or Other Mailing Address)
City
Zip Code
State
Address (Street or Other Mailing Address)
ATTORNEY-IN-FACT’S NAME AND ADDRESS
(If more than two, see Designation of Attorney-in-Fact in the instructions.)
TAXPAYER’S NAME AND ADDRESS
The attorneys-in-fact designated on this form have the authority to receive condential information on behalf of the taxpayer and the
power to perform the following acts with respect to the designated tax matters. Strike through any items which will not be granted.
Fully represent the taxpayer in any hearing, determination, or appeal.
Enter into any compromise with the Department.
Execute waivers, including offers of waivers, of restrictions on assessment or collection of tax deciencies.
Execute waivers of notice of disallowance of a claim for credit or refund.
Execute consents extending the statutory period for issuing a notice of deciency determination.
Receive, but not endorse or collect, checks in payment of any refund of taxes, penalties, or interest.
Receive all notices and other written communications with respect to the taxpayer in proceedings involving the above matters.
If more than one attorney-in-fact is named, enter name of the attorney-in-fact to receive these notices.
Perform other acts, specically:
7-139-1978 Rev. 7-2012 Supersedes 7-139-1978 Rev. 9-2009
Date
Date
Title, If Applicable
Title, If Applicable
Signature
Print Name Email Address
Signature
Print Name Email Address
Power of Attorney
FORM
33
The taxpayer appoints the above attorneys-in-fact for purposes of duly authorized representation in any proceedings with the Nebraska
Department of Revenue (Department) with respect to those tax categories, tax matters, and tax periods indicated below:
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
this Power of Attorney on behalf of the taxpayer.
Tax Matter of Representation
Tax Category Tax Period
sign
here
REVOCATION OF PRIOR POWERS OF ATTORNEY
A. I choose to revoke all prior powers of attorney on le with the Department with respect to the same tax matters, and tax periods
listed above, except the following:
B. I choose to revoke all powers of attorney on le with the Department.
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Nebraska Tax Power of Attorney Form
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