Form Poa-1 - Power Of Attorney - Ne York City Department Of Finance Page 4
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Taxpayer’s identification number
8. Declaration of representative(s)
(to be completed by each representative)
I agree to represent the above named taxpayer(s) in accordance with this power of attorney. I affirm that my representation will not violate
the provisions of the Ethics in Government Act or section 2604(d) of Chapter 68 of the New York City Charter restricting appearances by a
former government employee before his or her former agency. I have read a summary of these restrictions reproduced in the instructions to
this form.
I am (indicate all that apply):
1 an attorney-at-law licensed to practice in New York State
4 a New York State resident enrolled as an agent to practice
before the Internal Revenue Service
2 a certified public accountant duly qualified to practice in
5 an employee not a corporate officer (if the taxpayer is a
New York State
corporation)
3 a public accountant enrolled with the New York State
6 other:
Education Department
Designation(s)
Representative’s
Signature
Date
PTIN, SSN, or EIN
(use number(s)
from above list)
IF THIS DECLARATION OF REPRESENTATIVE IS NOT COMPLETED IN ITS ENTIRETY, THE POWER OF ATTORNEY WILL BE
RETURNED.
0294100094
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Parent category: Legal