Form Poa-1-I - Power Of Attorney - Nys Finance
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4New York State Department of Taxation and Finance
New York City Department of Finance
Power of Attorney
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.
1. Taxpayer information
(Taxpayer(s) must sign and date this form - please print or type.)
Taxpayer’s name
Taxpayer’s identification number
(see instructions)
Spouse’s name
Spouse’s SSN
(if joint tax return)
(if applicable)
Mailing address
City
State
ZIP code
Spouse’s mailing address
City
State
ZIP code
(if different from above)
The taxpayer(s) named above appoints the individual(s) named below as the taxpayer’s or taxpayers’ attorney(s)-in-fact:
2. Representative information
(Representative(s) must complete section 8 on page 4 of this form.)
Representative’s name
Telephone number
Fax number
(
)
(
)
Mailing address
Representative’s NYTPRIN
(include firm name, if any)
( if applicable)
City
State
ZIP code
E-mail address
Representative’s name
Telephone number
Fax number
(
)
(
)
Mailing address
Representative’s NYTPRIN
(include firm name, if any)
( if applicable)
City
State
ZIP code
E-mail address
Representative’s name
Telephone number
Fax number
(
)
(
)
Mailing address
Representative’s NYTPRIN
(include firm name, if any)
( if applicable)
City
State
ZIP code
E-mail address
to represent the taxpayer(s) in connection with the following tax matter(s):
3. Tax matter(s) — For estate tax matters, use Form ET-14, Estate Tax Power of Attorney, instead of this form.
Type(s) of tax(es)
Tax year(s), period(s), or transaction(s)
Notice/assessment/Audit ID number(s)
(may enter more than one)
with full power to receive confidential information and to perform any and all acts that the taxpayer(s) can perform with respect to the above specified
tax matter(s), except for signing tax returns or delegating his/her/their authority (unless specifically 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 ..................
029001140094
POA-1 (9/10) Page 1 of 4
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