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New York Estate Tax Power of Attorney Form


New York Estate Tax Power of Attorney Form
New York Estate Tax Power of Attorney Form
Estate Tax
Power of Attorney
Read all the instructions on the back. These instructions explain how the
Department will interpret certain information entered on this power of attorney.
ET-14
(6/13)
1. Executors information Print or type your name, social security number (SSN), and mailing address in the space provided
Executor’s name Executor’s SSN
Mailing address
City,village,town,orpostofce State ZIPcode
The executor named above appoints the person(s) named below as his/her attorney(s)-in fact:
2. Representative information (Representative must sign and date this form on back.)
Representative’s name Mailing address (include rm name, if any) Telephone/fax number
to represent the executor before the Department of Taxation and Finance in connection with the following estate:
3. Estate information
Decedent’s name SSN County of residence Date of death
withfullpowertoreceivecondentialinformationandtoperformanyandallactsthattheexecutorcanperformwithrespecttotax
matters,includingexecutingwaiversofrestrictiononassessmentsofdeciencies,andconsenttoextensionofanystatutoryor
regulatorytimelimit.Ifyoudo not want any of the above representative(s) to have full power as described above, check this box
and see instructions.................................................................................................................................................................................
4. Retention/revocation of prior Power(s) of Attorney
Thelingofthispowerofattorneyautomaticallyrevokesallearlierpower(s)ofattorneyonlewiththeNewYorkStateDepartment
ofTaxationandFinancefortheaboveestate.Ifyoudonot want to revoke a prior power of attorney, check this box. Attach a copy of
any power of attorney you want to remain fully in effect ..........................................................................................................................
5. Notices and decisions
Copiesofstatutorynoticesaddressedtotheexecutorinvolvingtheaboveestatewillbesenttotherstrepresentativenamedabove.
Ifyoudo not wantnoticessenttotherstrepresentativenamedabove,enterthenameoftherepresentative
designatedabove(orontheattachedpowerofattorneypreviouslyled)thatyouwanttoreceivenotices
6. Executor signature
Signature Date
ThisPowerofAttorneymustbeacknowledgedbeforeanotarypublicor witnessed by two disinterested individuals, unless the
appointedrepresentativeislicensedtopracticeinNewYorkStateasanattorney-at-law,certiedpublicaccountant,orpublic
accountant,orisaNewYorkStateresidentenrolledasanagenttopracticebeforetheInternalRevenueService.
Thepersonsigningastheaboveexecutorappearedbeforeusandcertiedthatheorshehadtheauthoritytoexecutethispower
of attorney.
Name of witness (print and sign) Date Name of witness (print and sign) Date
Title/Relationship of witness (please type or print) Title/Relationship of witness (please type or print)
Acknowledgment
StateofNewYork ss:
County of On this day of , , before me personally came,
to me known to be the person described in the foregoing Power of Attorney; and he/she acknowledged that
he/she executed the same.
SignatureofNotaryPublic Date
Notary public: afx stamp (or other indication of notary’s authority)
7. Acknowledgment or witnessing the Power of Attorney
New York Estate Tax Power of Attorney Form
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