Form Nyc-Pa - Power Of Attorney

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N E W Y O R K C I T Y D E P A R T M E N T O F F I N A N C E
P O W E R O F A T T O R N E Y
F I N A N C E
NEW
YORK
Please read the instructions for this form before completing. These instructions explain how the
G
THE CITY OF NEW YORK
information entered on this power of attorney will be interpreted and the extent of the powers granted.
DEPARTMENT OF FINANCE
n y c . g o v / f i n a n c e
1 - TAXPAYER INFORMATION (Taxpayer must sign and date this form - please print or type)
Taxpayer’s name
Taxpayer’s EIN or SSN
Mailing address
State of incorporation (if applicable)
City, village, town, or post office
State
ZIP code
The taxpayer named above appoints the person(s) named below as his/her/its attorney(s)-in-fact:
2 - REPRESENTATIVE(S) INFORMATION (Representative(s) must sign and date this form on back)
Representative’s name
Mailing address (include firm name, if any)
Telephone and fax numbers
to represent the taxpayer in connection with the following tax matter(s):
3 - TAX MATTER(S)
Type(s) of tax(es) (may enter more than one)
Tax year(s), period(s), or transaction(s)
Notice/assessment number(s)
with full power to receive confidential information and to perform any and all acts that the taxpayer can perform
with respect to the above specified tax matter(s), except for signing tax returns or delegating his or her authority
(unless authorized below). If you do not want any of the above representative(s) to have full power as described above,
K
check this box and attach a signed and dated explanation.....................................................................................................................
I authorize the above representative(s) to sign tax returns for tax matters indicated above (see instr.) (sign here):
_______________________________
NOTE: This authorization is not valid unless the Commissioner of Finance has granted written permission for a
representative to sign tax returns for the taxpayer and a copy of that written permission is attached hereto.
I authorize the above representative(s) to delegate his or her authority to another (see instructions) (sign here):
________________________________
If this Power of Attorney DOES NOT APPLY with respect to appearances before the New York City Tax Appeals
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Tribunal, check this box ..........................................................................................................................................................................
4 - RETENTION/REVOCATION OF PRIOR POWER(S) OF ATTORNEY
The filing of this power of attorney automatically revokes all earlier powers of attorney on file for the same tax matter(s)
and year(s), period(s), or transaction(s) covered by this document. If you do not want to revoke a prior power of attorney,
K
check this box and attach a copy of any power of attorney you want to remain fully in effect ................................................................
5 - NOTICES AND CERTAIN OTHER COMMUNICATIONS
Where statutory notices and certain other communications involving the above tax matter(s) are sent to a representative, these docu-
ments will be sent to the first representative named above. If you do not want notices and certain other communications sent to the
first representative named above, enter the name of the representative designated above (or on the attached power of attorney previ-
ously filed and remaining in effect) that you want to receive notices, etc.
__________________________________________________________________________
6 - TAXPAYER SIGNATURE
If the taxpayer named above is other than an individual: I certify that I am acting in the capacity of a corporate officer, partner (except a
limited partner), member or manager of a limited liability company, or fiduciary on behalf of the taxpayer, and that I have the authority to
execute this power of attorney on behalf of the taxpayer.
Signature
Taxpayer’s telephone and fax numbers
Date
Type or print name of person signing this form if not the taxpayer named above
Title, if applicable
,
AFFIX CORPORATE SEAL
IF APPLICABLE

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