Authorization To Represent An Entity, Fiduciary Or Attorney-In-Fact In An Application For Correction Of Property Tax Assessment
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1Nassau County, New York • Assessment Review Commission
AR 11
2015-16
AUTHORIZATION TO REPRESENT AN ENTITY, FIDUCIARY OR ATTORNEY-IN-FACT
IN AN APPLICATION FOR CORRECTION OF PROPERTY TAX ASSESSMENT
The individual or entity for which I am authorized to act owns the listed property or otherwise bears responsibility for payment of
the taxes. I have signed this form on the date indicated to authorize the individual or firm named below to act as the taxpayer’s
representative in an application filed during the period January 2, 2014 to March 3, 2014. I authorize the Assessment Review
Commission to communicate directly with the named representative in all matters relating to the application.
Name of taxpaying entity or individual
________________________________________________________________________________________________________
Name, title and business address of person signing this authorization for the taxpayer
________________________________________________________________________________________________________
My capacity is A
Attorney-in-fact (POA)
B
Member or manager of a limited liability company taxpayer (LLC)
C
General partner of taxpayer
D
Officer of a corporate taxpayer
E
Qualified fiduciary for taxpayer
F
Officer of taxpayer’s corporate* member or partner
G
Officer of condominium association
H
Other: _____________________________________________________________________________________________
* Name of corporation ____________________________________________________________________________________
Representative ___________________________________________________________________________________________
Additional authorizations (if checked):
Administrative proceeding to review village or city assessment for 2014-15
Administrative proceeding to review village or city assessment for 2015-16
Judicial proceeding to review assessment under Article 7 of the Real Property Tax Law for 2014-15
Judicial proceeding to review assessment under Article 7 of the Real Property Tax Law for 2015-16
List all tax parcels for which authorization is given.
Check here if lots are listed on an attachment.
Parcel number (section, block, lot, bldg, unit)
house # and street or description
____________________________________________
________________________________________________________
____________________________________________
________________________________________________________
____________________________________________
________________________________________________________
____________________________________________
________________________________________________________
____________________________________________
________________________________________________________
____________________________________________
________________________________________________________
____________________________________________
________________________________________________________
____________________________________________
________________________________________________________
____________________________________________
________________________________________________________
____________________________________________
________________________________________________________
____________________________________________
________________________________________________________
Number of pages attached ________________
This authorization is valid only when dated and signed.
______________________________________________
____________________________
Signature for applicant-taxpayer
Date signed
If I sign as an attorney-in-fact, I certify that my power of attorney remains in effect, I have attached a photocopy of the power, and
listed the name and address of my grantor here: _________________________________________________________________
File a dated and signed original of this form between January 2, 2014 and March 3, 2014.
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