Form 2848-Me - Power Of Attorney And Declaration Of Representative Template

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Maine Revenue Services

Power of Attorney and

FORM

24 State House Station

Declaration of Representative

2848-ME

Augusta, ME 04330-0024

PART I

Power of Attorney

1 Taxpayer information: (Taxpayer(s) must sign and date this form below.)

Taxpayer(s) name(s)

Social Security Number(s)

Federal Identiﬁ cation Number

Street Address

Telephone Number

City, State and Zip

2 Representative(s): Hereby appoint(s) the following individuals(s)*

Name

Address

Telephone Number

as attorney(s)-in-fact to represent the taxpayer(s) before Maine Revenue Services for the following tax matter(s). Specify the type(s)

of tax and year(s) or period(s) at issue, or date of death, if estate tax:

3 Tax Matters:

Type of Tax

Maine Form Number

Year(s) or Period(s)

(Individual, Corporate, Sales, Excise, Etc.)

(1040ME, 1120ME, Sales, Excise, Etc.)

(Date of Death if Estate Tax)

The attorney(s)-in-fact listed above are authorized, subject to revocation, to receive conﬁ dential information and to perform any and all

acts that the principal(s) can perform with respect to the above speciﬁ ed tax matter(s). List any speciﬁ c additions or deletions to the

acts otherwise authorized in this power of attorney: _________________________________________________________________

_________________________________________________________________________________________________________

4 Notices and Communications. By ﬁ ling this Form 2848-ME, the taxpayer authorizes Maine Revenue Services to send either

originals or copies of notices and any other written communications concerning the taxpayer in proceedings involving the above tax

matter(s) to the representative ﬁ rst named above.

NOTICE: This authorization does not require Maine Revenue Services to send notices to the representative; in many circumstances,

especially computer generated notices, only the taxpayer may be sent the written communication, not the representative.

5 Retention/revocation of prior power(s) of attorney: The ﬁ ling of this Power of Attorney automatically revokes all earlier power(s)

of attorney on ﬁ le with Maine Revenue Services for the same tax matter(s) and year(s) or period(s) covered by this document. If you

do not want a prior power of attorney revoked, check here ...............................................................................................................

(You must attach a copy of any power of attorney you want to remain in effect.)

6 Signature of or for taxpayer(s): If a tax matter concerns a joint return, both husband and wife must sign if joint representation

is requested. If signed by a corporate ofﬁ cer, partner, or ﬁ duciary on behalf of the taxpayer(s), I certify that I have the authority to

execute this power of attorney on behalf of the taxpayer.

____________________________________________

_________________________________________

_________________

Signature

Title, if applicable

Date

____________________________________________

Print Name