Form Navjag Form 5801/16 - Special Power Of Attorney (Taxes)
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1SPECIAL POWER OF ATTORNEY (TAXES)
PREAMBLE: This is a MILITARY POWER OF ATTORNEY prepared pursuant to Title 10, United States Code, § 1044b, and executed by a person
authorized to receive legal assistance from the military services. Federal law exempts this power of attorney from any requirement of form, substance,
formality, or recording that is prescribed for powers of attorney by the laws of a state, the District of Columbia, or a territory, commonwealth, or
possession of the United States. Federal law specifies that this power of attorney shall be given the same legal effect as a power of attorney prepared
and executed in accordance with the laws of the jurisdiction where it is presented.
KNOW ALL PERSONS: That I, ___________________________________, currently residing at _________________________________________
by this document do make and appoint _____________________________, whose address is ____________________________________________
as my true and lawful attorney-in-fact to act as follows, GRANTING unto my said Attorney full power to:
Prepare, complete, sign and file my ___________ (indicate Form 1040, 1040A, 1040EZ) Federal and/or ____________________State Income tax
return; to endorse, accept, receive, sign, and deposit my local, state, and federal income tax refund checks for tax year
____________; and to receive all
notices and other written communications pertaining to my taxes for tax year
__ .
TERMINATION: This power shall remain in full force and effect until _____________________, unless sooner revoked or terminated by me.
Notwithstanding my insertion of a specific expiration date herein, if on the above specified expiration date I shall be, or have been, carried in a military
status of “missing”, “missing-in-action” or “prisoner of war,” then this power of attorney shall automatically remain valid and in full effect until sixty (60)
days after I have returned to the United States Military control following termination of such status. This power of attorney shall not be affected by the
disability of the principal.
IN WITNESS WHEREOF, I have hereunto set my hand and seal on this day, ____________________.
_____________________________________
Grantor’s Signature
WITNESSED:
PRINT NAME:
PRINT NAME:
PRINT ADDRESS
PRINT ADDRESS:
_________________________________________________________________________________________________________________________
ACKNOWLEDGEMENT BY NOTARY PUBLIC
_________________________________________________________________________________________________________________________
STATE OF ________________________, COUNTY OF _______________________, ss.
The foregoing instrument was acknowledged before me by _________________________and the above named two witnesses, this ____ day
of ____________________, _______.
________________________________
Print Name:
Notary Public
_________________________________________________________________________________________________________________________
ACKNOWLEDGEMENT BY A PERSON AUTHORIZED TO ACT AS A NOTARY PURSUANT TO TITLE 10 U.S.C. 1044a
_________________________________________________________________________________________________________________________
With the United States Armed Forces
At ____________________________, the forgoing instrument was acknowledged before me by ______________________________ and the above
named two witnesses, this ____day of ________________,_______. I do further certify that I am a person in the service of the U.S. Armed Forces
authorized the general powers of a notary public under Title 10 U.S.C. 1044a and JAGMAN Chapter IX.
__________________________________
__________________________________
Print Name, Grade, Armed Force
NO SEAL REQUIRED
NAVJAG Form 5801/16
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