Form NYC-PA "Power of Attorney" - New York City

What Is Form NYC-PA?

This is a legal form that was released by the New York City Department of Finance - a government authority operating within New York City. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the New York City Department of Finance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form NYC-PA by clicking the link below or browse more documents and templates provided by the New York City Department of Finance.

ADVERTISEMENT
ADVERTISEMENT

Download Form NYC-PA "Power of Attorney" - New York City

1214 times
Rate (4.3 / 5) 85 votes
N E W Y O R K C I T Y D E P A R T M E N T O F F I N A N C E
P O W E R O F A T T O R N E Y
F I N A N C E
NEW
YORK
Please read the instructions for this form before completing. These instructions explain how the
G
THE CITY OF NEW YORK
information entered on this power of attorney will be interpreted and the extent of the powers granted.
DEPARTMENT OF FINANCE
n y c . g o v / f i n a n c e
1 - TAXPAYER INFORMATION (Taxpayer must sign and date this form - please print or type)
Taxpayer’s name
Taxpayer’s EIN or SSN
Mailing address
State of incorporation (if applicable)
City, village, town, or post office
State
ZIP code
The taxpayer named above appoints the person(s) named below as his/her/its attorney(s)-in-fact:
2 - REPRESENTATIVE(S) INFORMATION (Representative(s) must sign and date this form on back)
Representative’s name
Mailing address (include firm name, if any)
Telephone and fax numbers
to represent the taxpayer in connection with the following tax matter(s):
3 - TAX MATTER(S)
Type(s) of tax(es) (may enter more than one)
Tax year(s), period(s), or transaction(s)
Notice/assessment number(s)
with full power to receive confidential information and to perform any and all acts that the taxpayer can perform
with respect to the above specified tax matter(s), except for signing tax returns or delegating his or her authority
(unless authorized below). If you do not want any of the above representative(s) to have full power as described above,
K
check this box and attach a signed and dated explanation.....................................................................................................................
I authorize the above representative(s) to sign tax returns for tax matters indicated above (see instr.) (sign here):
_______________________________
NOTE: This authorization is not valid unless the Commissioner of Finance has granted written permission for a
representative to sign tax returns for the taxpayer and a copy of that written permission is attached hereto.
I authorize the above representative(s) to delegate his or her authority to another (see instructions) (sign here):
________________________________
If this Power of Attorney DOES NOT APPLY with respect to appearances before the New York City Tax Appeals
K
Tribunal, check this box ..........................................................................................................................................................................
4 - RETENTION/REVOCATION OF PRIOR POWER(S) OF ATTORNEY
The filing of this power of attorney automatically revokes all earlier powers of attorney on file for the same tax matter(s)
and year(s), period(s), or transaction(s) covered by this document. If you do not want to revoke a prior power of attorney,
K
check this box and attach a copy of any power of attorney you want to remain fully in effect ................................................................
5 - NOTICES AND CERTAIN OTHER COMMUNICATIONS
Where statutory notices and certain other communications involving the above tax matter(s) are sent to a representative, these docu-
ments will be sent to the first representative named above. If you do not want notices and certain other communications sent to the
first representative named above, enter the name of the representative designated above (or on the attached power of attorney previ-
ously filed and remaining in effect) that you want to receive notices, etc.
__________________________________________________________________________
6 - TAXPAYER SIGNATURE
If the taxpayer named above 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.
Signature
Taxpayer’s telephone and fax numbers
Date
Type or print name of person signing this form if not the taxpayer named above
Title, if applicable
,
AFFIX CORPORATE SEAL
IF APPLICABLE
N E W Y O R K C I T Y D E P A R T M E N T O F F I N A N C E
P O W E R O F A T T O R N E Y
F I N A N C E
NEW
YORK
Please read the instructions for this form before completing. These instructions explain how the
G
THE CITY OF NEW YORK
information entered on this power of attorney will be interpreted and the extent of the powers granted.
DEPARTMENT OF FINANCE
n y c . g o v / f i n a n c e
1 - TAXPAYER INFORMATION (Taxpayer must sign and date this form - please print or type)
Taxpayer’s name
Taxpayer’s EIN or SSN
Mailing address
State of incorporation (if applicable)
City, village, town, or post office
State
ZIP code
The taxpayer named above appoints the person(s) named below as his/her/its attorney(s)-in-fact:
2 - REPRESENTATIVE(S) INFORMATION (Representative(s) must sign and date this form on back)
Representative’s name
Mailing address (include firm name, if any)
Telephone and fax numbers
to represent the taxpayer in connection with the following tax matter(s):
3 - TAX MATTER(S)
Type(s) of tax(es) (may enter more than one)
Tax year(s), period(s), or transaction(s)
Notice/assessment number(s)
with full power to receive confidential information and to perform any and all acts that the taxpayer can perform
with respect to the above specified tax matter(s), except for signing tax returns or delegating his or her authority
(unless authorized below). If you do not want any of the above representative(s) to have full power as described above,
K
check this box and attach a signed and dated explanation.....................................................................................................................
I authorize the above representative(s) to sign tax returns for tax matters indicated above (see instr.) (sign here):
_______________________________
NOTE: This authorization is not valid unless the Commissioner of Finance has granted written permission for a
representative to sign tax returns for the taxpayer and a copy of that written permission is attached hereto.
I authorize the above representative(s) to delegate his or her authority to another (see instructions) (sign here):
________________________________
If this Power of Attorney DOES NOT APPLY with respect to appearances before the New York City Tax Appeals
K
Tribunal, check this box ..........................................................................................................................................................................
4 - RETENTION/REVOCATION OF PRIOR POWER(S) OF ATTORNEY
The filing of this power of attorney automatically revokes all earlier powers of attorney on file for the same tax matter(s)
and year(s), period(s), or transaction(s) covered by this document. If you do not want to revoke a prior power of attorney,
K
check this box and attach a copy of any power of attorney you want to remain fully in effect ................................................................
5 - NOTICES AND CERTAIN OTHER COMMUNICATIONS
Where statutory notices and certain other communications involving the above tax matter(s) are sent to a representative, these docu-
ments will be sent to the first representative named above. If you do not want notices and certain other communications sent to the
first representative named above, enter the name of the representative designated above (or on the attached power of attorney previ-
ously filed and remaining in effect) that you want to receive notices, etc.
__________________________________________________________________________
6 - TAXPAYER SIGNATURE
If the taxpayer named above 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.
Signature
Taxpayer’s telephone and fax numbers
Date
Type or print name of person signing this form if not the taxpayer named above
Title, if applicable
,
AFFIX CORPORATE SEAL
IF APPLICABLE
:
/
:
Form NYC-PA
_______________________________________
________________________
Page 2
NAME
EIN
SSN
7 - ACKNOWLEDGMENT OR WITNESSING THE POWER OF ATTORNEY
This Power of Attorney must be acknowledged before a notary public or witnessed by one disinterested individual, unless the ap-
pointed 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(s) signing as the above taxpayer appeared before me and executed this power of attorney.
Name of witness (print and sign)
Date
Mailing address of witness (please type or print)
ACKNOWLEDGMENT - INDIVIDUAL
ACKNOWLEDGMENT - CORPORATE
STATE OF
STATE OF
SS:
SS:
COUNTY OF
COUNTY OF
On this
day of
,
,
On this
day of
,
,
_____________________________
_____________________________________________
___________________
_____________________________
________________________________________________
___________________
before me personally came,
before me personally came,
to me known
______________________________________________________________________________,
________________________________________________________________,
to me known, who, being by me duly sworn, did say that he/she resides at
to be the person described in the foregoing Power of Attorney; and he/she acknowledged
that he/she executed the same.
______________________________________________________________________________________________________________________
INSERT ADDRESS
that he/she is the
of
______________________________________
____________________________________________________,
the corporation described in the foregoing Power of Attorney; and that he/she signed
his/her name thereto by authority of the board of directors of said corporation.
Signature of notary public
Date
Signature of notary public
Date
M
M
Notary public: L affix stamp L (or other indication of notaryʼs authority).
Notary public: L affix stamp L (or other indication of notaryʼs authority).
ACKNOWLEDGMENT - LIMITED LIABILITY COMPANY
ACKNOWLEDGMENT - PARTNERSHIP/LLP
STATE OF
STATE OF
SS:
SS:
COUNTY OF
COUNTY OF
On this
day of
,
,
On this
day of
,
,
____________________________
________________________________________________
_________________
_____________________________
_________________________________________________
__________________
before me personally came,
to me known,
before me personally came,
to me known,
_________________________________________________________,
____________________________________________________________,
who, being by me duly sworn, did say that he/she/they/it reside(s) at
who, being by me duly sworn, did say that he/she/they/it reside(s) at
_______________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
INSERT ADDRESS
INSERT ADDRESS
that he/she/they/it is (are) a partner(s) of
that he/she/they/it is (are) a member(s) or manager(s) of
______________________________________________________________
__________________________________________
the partnership described in the foregoing Power of Attorney; and that he/she/they/it is
the limited liability company described in the foregoing Power of Attorney; and that
(are) empowered to and did execute the same.
he/she/they/it is (are) empowered to and did execute the same.
Signature of notary public
Date
Signature of notary public
Date
M
M
Notary public: L affix stamp L (or other indication of notaryʼs authority).
Notary public: L affix stamp L (or other indication of notaryʼs authority).
8 - DECLARATION OF REPRESENTATIVE (to be completed by representative)
I agree to represent the above-named taxpayer in accordance with this power of attorney. I affirm that my representation will not violate the
provisions of section 2604 of the New York City Charter restricting appearances by current employees or former government employees. I
have read a summary of these restrictions reproduced in the instructions to this form.
I am (indicate all that apply):
4. a New York State resident enrolled as an agent to practice before the IRS
1. an attorney-at-law licensed to practice in New York State.
5. an employee, not a corporate officer (if the taxpayer is a corporation)
2. a certified public accountant duly qualified to practice in New York State
6. other.
3. a public accountant enrolled with the New York State Education Department
_______________________________________________________________________________
Designation
(use number(s)
Signature
Date
from above list)
NYC-PA
Page of 2