Form Et-14 - Estate Tax Power Of Attorney

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ET-14
Estate Tax
Power of Attorney
(6/13)
Read all the instructions on the back. These instructions explain how the
Department will interpret certain information entered on this power of attorney.
1. Executor’s 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 office
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.)
(include firm name, if any)
Representative’s name
Mailing address
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 confidential 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 deficiencies, 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 filing of this power of attorney automatically revokes all earlier power(s) of attorney on file 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 first representative named above.
If you do not want notices sent to the first representative named above, enter the name of the representative
designated above (or on the attached power of attorney previously filed) that you want to receive notices
6. Executor signature
Signature
Date
7. Acknowledgment or witnessing the Power of Attorney
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, certified 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 certified 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: affix stamp (or other indication of notary’s authority)

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