Form Dp-2848 - Power Of Attorney (Poa) - New Hampshire Department Of Revenue Administration

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DO NOT STAPLE
New Hampshire
DP-2848
Department of
Revenue Administration
DP28481511862
POWER OF ATTORNEY (POA)
SECTION 1 TAXPAYER INFORMATION
Name of Taxpayer
Taxpayer Identification Number
Taxpayer Identification Number
Name of Spouse (If filing jointly)
Department Issued License Number
Address of Taxpayer(s)
SECTION 2 REPRESENTATIVE(S) :
I/We hereby appoint the following representative(s) as attorney(s)-in-fact:
Name and Address of Representative
Telephone Number
Name and Address of Representative
Telephone Number
SECTION 3 ACTS AUTHORIZED (Must be filled out) - Said attorney(s)-in-fact to represent the taxpayer(s) before the Department of Revenue Administration
of the State of New Hampshire with respect to (see instructions for examples):
SECTION 4 SPECIFIC USE (Must be checked)
Said attorney(s)-in-fact shall, subject to revocation, have authority to receive confidential information and full power to perform on behalf of the
taxpayer(s) all acts necessary with respect to above tax matters.
Said attorney(s)-in-fact shall, subject to revocation, have authority to receive or inspect confidential tax information only.
This power of attorney revokes all prior powers of attorney relating to the above
SECTION 5 RETENTION/REVOCATION OF PRIOR POWERS OF ATTORNEY -
taxable period except:
SECTION 6 SIGNATURE(S)
If signed by a corporate officer or fiduciary on behalf of the taxpayer, I certify that I have the authority to execute this power of attorney.
Taxpayer Signature
Print Signatory Name & Title
MMDDYYYY
Spouse Signature (If applicable)
Print Signatory Name & Title
MMDDYYYY
DP-2848
MAIL TO: NH DRA, PO BOX 1388, CONCORD, NH 03302-1388
Rev 1.2 05/2015

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