Form N-848 - Power Of Attorney

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FORM
STATE OF HAWAII - DEPARTMENT OF TAXATION
N-848
POWER OF ATTORNEY
(REV. 2014)
(NOTE: References to “married”, “unmarried”, and “spouse” also means
“in a civil union”, “not in a civil union”, and “civil union partner”, respectively.)
PART I
POWER OF ATTORNEY (Please type or print.)
1 Taxpayer Information. Taxpayer(s) must sign and date this form on page 2, line 6.
Taxpayer name(s) and address (Please type or print.)
Social security number(s)
Federal employer
identification number
Daytime telephone number
Fax number
(
)
(
)
E-mail address
hereby appoint(s) the following representative(s) as attorney(s)-in-fact:
2 Representative(s) must be an individual and must sign and date this form on page 2, Part II.
Individual name and address
Telephone No. (
)
Fax No. (
)
E-mail address
Check if new: Address
Telephone
Fax
E-mail
Individual name and address
Telephone No. (
)
Fax No. (
)
E-mail address
Check if new: Address
Telephone
Fax
E-mail
Individual name and address
Telephone No. (
)
Fax No. (
)
E-mail address
Check if new: Address
Telephone
Fax
E-mail
Individual name and address
Telephone No. (
)
Fax No. (
)
E-mail address
Check if new: Address
Telephone
Fax
E-mail
to represent the taxpayer(s) before the Department of Taxation, State of Hawaii, for the following acts:
3 Acts authorized (you are required to complete this line 3). (Stating “All Taxes”, “All Forms”, or “All Periods” on line 3 is not acceptable.) With the
exception of the acts described in line 4b, I (we) authorize my (our) representative(s) to receive and inspect my (our) confidential tax information and to
perform acts that I (we) can perform with respect to the tax matters described below. For example, my (our) representative(s) shall have the authority to
sign any agreements, consents, tax clearance applications, or similar documents (but see instructions for authorizing a representative to sign a return).
Hawaii Tax I.D. Number
Type of Tax
Tax Form Number
Year(s) or Period(s)
(Income, General Excise, etc.)
(N-11, N-13, G-49, etc.)
W __ __ __ __ __ __ __ __ - __ __
W __ __ __ __ __ __ __ __ - __ __
W __ __ __ __ __ __ __ __ - __ __
W __ __ __ __ __ __ __ __ - __ __
4a Additional acts authorized. In addition to the acts listed on line 3 above, I (we) authorize my (our) representative(s) to perform the following acts (see instructions):
 
 
 
Authorize disclosure to third parties;
Substitute or add representative(s);
Sign a return;
 
Other acts authorized:
4b Specific acts not authorized. My (our) representative(s) is (are) not authorized to endorse or otherwise negotiate any check (including directing or
accepting payment by any means, electronic or otherwise, into an account owned or controlled by the representative(s) or any firm or other entity with
whom the representative(s) is (are) associated) issued by the government in respect of a Hawaii tax liability.
List any specific deletions to the acts otherwise authorized in this power of attorney (see instructions):
FORM N-848

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