Form Poa-1-I - Power Of Attorney - Nys Finance (With Instructions) Page 2
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6Page 2 of 4 POA-1 (9/10)
Taxpayer’s identification number
I / We authorize the above representative(s) to sign tax returns for the tax matter(s) indicated above.
(If joint return, both taxpayers must sign.)
Your signature
Date
Spouse’s signature
Date
I / We authorize the above representative(s) to delegate his/her/their authority to another.
(If joint return, both taxpayers must sign.)
Your signature
Date
Spouse’s signature
Date
4. Retention/revocation of prior power(s) of attorney
This power of attorney (POA) only applies to tax matters administered by the New York State Tax Department, the New York City
Department of Finance, or both. Executing and filing this POA revokes all powers of attorney previously executed and filed with an
agency for the same tax matter(s) and year(s), period(s) or transaction(s) covered by this document. If there is an existing POA that
you do not want revoked, attach a signed and dated copy of each POA you want to remain in effect and mark an X in this box. .........
5. Notices and certain other communications
In those instances where statutory notices and certain other communications involving the tax matter(s) listed on page 1 are sent to a
representative, these documents will be sent to the first representative named in section 2. If you do not want notices and certain other
communications sent to the first representative, enter the name of the representative designated on page 1 (or on the attached power of
attorney previously filed and remaining in effect) that you want to receive notices, etc.
Representative’s name: _________________________________________________________________
If you do not want notices and certain other communications to go to any representative, enter None on the line above.
6. Taxpayer signature
If a joint tax return was filed for New York State, New York City, or both, and both spouses request the same representative(s), both spouses
must sign below.
If the taxpayer named in section 1 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.
IF NOT SIGNED AND DATED, THIS POWER OF ATTORNEY WILL BE RETURNED.
Signature
Taxpayer’s telephone number
Taxpayer’s fax number
Date
(
)
(
)
Name of person signing this form
Title, if applicable
(type or print)
Spouse’s signature
Spouse’s telephone number
Spouse’s fax number
Date
(
)
(
)
Affix corporate seal here, if applicable
7. Acknowledgment or witnessing the power of attorney
This power of attorney must be acknowledged by the taxpayer(s) before a notary public (see next page for acknowledgment formats)
or witnessed by two disinterested individuals, unless the appointed representative(s) is licensed to practice in New York State as an
attorney-at-law, certified public accountant, public accountant, or is a New York State resident enrolled as an agent to practice before the
Internal Revenue Service.
The person(s) signing as the above taxpayer(s) appeared before us and executed this power of attorney.
Signature of witness
Signature of witness
Name of witness
Date
Name of witness
Date
(type or print)
(type or print)
Mailing address of witness
Mailing address of witness
(type or print)
(type or print)
City
State
ZIP code
City
State
ZIP code
0292100094
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