Fillable Form Dp-2848 - Power Of Attorney (Poa) printable pdf download

FORM

NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION

DP-2848

POWER OF ATTORNEY (POA)

NOTE

SECTION 4

All applicable items must be ﬁ lled in to properly complete Form DP-2848

One of the two boxes MUST BE CHECKED. The ﬁ rst box should be

New Hampshire Power of Attorney. An incomplete form will prohibit direct

checked if the taxpayer wants the representative to be able to receive

conﬁ dential information as well as perform on behalf of the taxpayer for

communication between the Department and the appointee.

all acts necessary for the tax matters at issue. The second box should

SECTION 1

be checked if the taxpayer wants the representative to be able to receive

Enter the complete taxpayer's name, address including ZIP code+4,

conﬁ dential information only.

and federal identiﬁ cation number, social security number or Department

SECTION 5

identiﬁ cation number if appropriate. Any DRA issued license or registration

number of the taxpayer should also be included in this section.

This Power of Attorney form will revoke all prior power of attorney

authorizations relating to the speciﬁ c tax matters referenced in section

SECTION 2

3 above, unless prior appointees are excepted here. If a prior POA was

Enter the name, address, including ZIP code+4 and telephone number

completed for a CPA and the taxpayer completes a second POA to add

of the appointee. If the name of a ﬁ rm is indicated, then the Department

an attorney, the prior POA will automatically be revoked unless the CPA's

will be authorized to correspond directly with anyone in that ﬁ rm. If an

name is again entered in this section.

individual(s) is indicated, the Department will be authorized to correspond

directly with the individual(s) named only. A ﬁ rm name that is part of an

SECTION 6 PART A

individual's address does not mean that the employees of the ﬁ rm can

The taxpayer is required to sign, in ink, and date the POA. The original

represent the taxpayer.

signed form POA must be sent to the Department at the address below.

SECTION 6 PART B

SECTION 3

A brief description or listing of the returns and/or tax matters at issue.

If the appointee is someone other than a CPA, an attorney, or the preparer

Example: 2006 and 2007 New Hampshire Corporation Business Tax

of the subject tax returns, the form needs to be signed, in ink, and dated by

Returns, 2007 New Hampshire Interest & Dividends Tax Return, or All

two witnesses. The original signed POA should be mailed to the address

New Hampshire tax matters, etc.

below.

NEED HELP?

Any questions regarding completion of Form DP-2848 Power of Attorney should be directed to: Central Taxpayer Services at: (603) 271-2191. Individuals

with hearing or speech impairments may call TDD Access: Relay NH 1-800-735-2964.

SECTION 1 Name, address including ZIP code+4 and identifying number of taxpayer(s):

SECTION 2 I/We hereby appoint [name, address including ZIP code+4 and telephone number of appointee(s)]:

SECTION 3 As attorney(s)-in-fact to represent the taxpayer(s) before the Department of Revenue Administration of the State of New Hampshire with

respect to:

SECTION 4 - MUST BE CHECKED

Said attorney(s)-in-fact shall, subject to revocation, have authority to receive conﬁ dential information and full power to perform on behalf of the

taxpayer(s) all acts necessary with respect to above tax matters.

Said attorney(s)-in-fact shall, subject to revocation, have authority to receive or inspect conﬁ dential tax information only.

SECTION 5 This power of attorney revokes all prior powers of attorney relating to the above taxable period except:

SECTION 6, PART A SIGNATURE (IN INK) OF THE TAXPAYER(S): If signed by a corporate ofﬁ cer or ﬁ duciary on behalf of the taxpayer, I certify

that I have the authority to execute this power of attorney on behalf of the taxpayer.

Signature (in ink)

Title

Date

FOR DRA USE ONLY

SECTION 6, PART B IF THE POWER OF ATTORNEY IS GRANTED TO A PERSON OTHER THAN AN ATTORNEY, CERTIFIED

PUBLIC ACCOUNTANT OR THE PREPARER OF SUBJECT TAX RETURN(S), IT MUST BE WITNESSED BELOW.

The person signing as or for the taxpayer(s) is known to and signed (in ink) in the presence of the two disinterested witnesses

whose signatures appear here:

Witness Signature (in ink)

Date

Witness Signature (in Ink)

Date

Mail To: NH DRA, Audit Division, PO Box 457, Concord, NH 03302-0457

DP-2848

[pg 33]

Rev 09/2010

Form Dp-2848 - Power Of Attorney (Poa)

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