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New York Tax Power of Attorney Form


New York Tax Power of Attorney Form
New York Tax Power of Attorney Form
0291100094
Taxpayer’s name Taxpayer’s identication number (see instructions)
Spouse’s name (if joint tax return) Spouse’s SSN (if applicable)
Mailing address City State ZIP code
Spouse’s mailing address
(if different from above) City State ZIP code
1. Taxpayer information (Taxpayer(s) must sign and date this form - please print or type.)
New York State Department of Taxation and Finance
New York City Department of Finance
Power of Attorney
Type(s) of tax(es) Tax year(s), period(s), or transaction(s)
Notice/assessment/Audit ID number(s)
(may enter more than one)
3. Tax matter(s) — For estate tax matters, use Form ET-14, Estate Tax Power of Attorney, instead of this form.
The taxpayer(s) named above appoints the individual(s) named below as the taxpayer’s or taxpayers’ attorney(s)-in-fact:
to represent the taxpayer(s) in connection with the following tax matter(s):
POA-1 (9/10) Page 1 of 4
Read Form POA-1-I, Instructions for Form POA-1, before completing. These instructions explain how the information entered on this power
of attorney (POA) will be interpreted and the extent of the powers granted.
Representative’s name Telephone number Fax number
( ) ( )
Mailing address (include firm name, if any) Representative’s NYTPRIN ( if applicable)
City State ZIP code E-mail address
Representative’s name Telephone number Fax number
( ) ( )
Mailing address (include firm name, if any) Representative’s NYTPRIN ( if applicable)
City State ZIP code E-mail address
Representative’s name Telephone number Fax number
( ) ( )
Mailing address (include firm name, if any) Representative’s NYTPRIN ( if applicable)
City State ZIP code E-mail address
2. Representative information (Representative(s) must complete section 8 on page 4 of this form.)
with full power to receive condential information and to perform any and all acts that the taxpayer(s) can perform with respect to the above specied
tax matter(s), except for signing tax returns or delegating his/her/their authority (unless specically authorized; see page 2). If you do not want any
of the above representative(s) to have full power as described above, attach a signed and dated explanation and mark an X in this box ..................
New York Tax Power of Attorney Form
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