Enlarge image | Print Form Reset Form DO NOT STAPLE New Hampshire Department of DP-2848 *DP28482311862* Revenue Administration DP28482311862 POWER OF ATTORNEY (POA) SECTION 1- TAXPAYER INFORMATION Name of Taxpayer (Must match the tax return) Taxpayer Identification Number JOHN SMITH 1 2 3 4 5 6 7 8 9 Name of Spouse (If filing jointly) Taxpayer Identification Number BARBARA SMITH 3 2 5 6 4 5 4 5 4 Address of Taxpayer(s) Department Issued License Number 199 MAIN ST CONCORD NH 03301 SECTION 2- REPRESENTATIVE(S): I/We hereby appoint the following representative(s) as attorney(s)-in-fact: Name of Representative Telephone Number JOHN TURNER 6 0 3 2 3 0 2 3 0 0 Address of Representative 25 MAIN ST STE 600 Name of Representative Telephone Number Address of Representative Name of Representative Telephone Number Address of Representative SECTION 3 - ACTS AUTHORIZED (Must be filled out): Said attorney(s)-in-fact is authorized to represent the taxpayer(s) before the Department of Revenue Administration concerning all tax matters for the tax periods and tax types indicated below, except as otherwise indicated on Line (c) below: Line (a): All tax periods or the following tax period(s): Line (b): All tax types oronly the following (check all that apply): Business Taxes Interest and Dividends Tax Meals and Rentals Tax Real Estate Transfer Tax Other Line (c): If applicable, please describe any other limitations you wish to set on the above authorization: Line (d): This power of attorney shall not revoke any prior powers of attorney you have authorized before the Department. To revoke all prior powers of attorney, check this box . SECTION 4 - SIGNATURE(S) If signed by a corporate officer or fiduciary on behalf of the taxpayer, I certify that I have the authority to execute this power of attorney. Taxpayer Signature Print Signatory Name & Title Today's Date (MMDDYYYY) JOHN SMITH 1 0 2 0 2 0 2 3 Spouse Signature (If applicable) Print Signatory Name & Title Today's Date (MMDDYYYY) BARBARA SMITH 1 0 2 0 2 0 2 3 FILE ONLINE AT GRANITE TAX CONNECT WWW.REVENUE.NH.GOV/GTC DP-2848 Version 1 8 0 /2023 or mail to NH DRA, PO Box 637, Concord, NH 03302-0637 |
Enlarge image | New Hampshire POWER OF ATTORNEY (POA) Department of DP-2848 INSTRUCTIONS Revenue Administration WHEN TO FILE A Power Of Attorney (POA) is required prior to the Department of Revenue Administration communicating with anyone other than the taxpayer regarding any issue relating to the taxpayer. WHERE TO FILE File on-line at Granite Tax Connect www.revenue.nh.gov/gtc,mail to NH DRA, Taxpayer Services Division, PO Box 637, Concord NH 03302-0637 , or email scanned document to POA@dra.nh.gov. PLEASE NOTE All applicable items must be filled in to properly complete Form DP-2848 New Hampshire Power of Attorney (POA). An incomplete form will prohibit direct communication between the Department and the representative. SECTION 1 - TAXPAYER INFORMATION Enter the taxpayer's name (must match the tax return), current mailing address including zip code, and taxpayer identification number (and Department issued license number if applicable). If current address is different from the address on file with the Department, submit form "DP-100 Report of Address Change" along with this form, or log into your GTC account to update your address. If joint returns are involved and you and your spouse are designating the same representative(s), also enter your spouse's name and taxpayer identification number (and Department issued license number if applicable). If you need to list additional taxpayers, an additional page may be attached with each taxpayer's name and taxpayer identification number. SECTION 2 - REPRESENTATIVE(S) Enter the name of the representative(s). This can be an individual(s) or the name of a firm. What you enter in the Name of Representative box determines who the Department will have authority to correspond with as your authorized representative. If you list only an individual(s) name from a firm, then only the individual(s) will have authority to represent you. If you put the firm name in the Name of Representative box then ANYONE with the firm will have the authority to represent you. Enter the current mailing address including zip code of the representative in the Address of Representative box below the Name of Representative box. Only the person(s) or firm named in the Name of Representative box has authorization to represent you with the Department. A firm name that is part of an individual's address does not mean that the employees of the firm can represent the taxpayer. Provide the representative's phone number in the space provided. If more than one name is listed, provide the phone number of the first person listed. This section allows for three representatives. If you have more than three, please attach an additional sheet and note "see attached" in one of the Name of Representative boxes. SECTION 3 - ACTS AUTHORIZED (MUST BE FILLED OUT) On Line (a), either check the "all" box to indicate that the representative applies to all tax periods, or limit the representation to a particular tax period(s) and provide the date range or period(s). If you enter only a year(s) (e.g. 2018) the representation will include any period (including any Meals and Rooms or Tobacco Tax periods, if authorized on Line (b)) that fall within that year. If you limit the representation to a date range, please be aware that your representative will not be permitted to discuss any other date range with the Department. Note: If you check both the "all" box and provide a date range, the representation will not be limited to the date range, but will apply to all dates and tax periods. On Line (b), check the boxes for the tax types that apply to your representation. If the representation applies to all taxes, check the "all" box. To limit the representation to one or more taxes, check all the appropriate boxes and for any taxes not shown, check the "other" box and identify the taxes on the line (for example MET or UPT). Note: If you check both the "all" box and the boxes for specific taxes, the representation will not be limited to a specific tax, but will apply to all tax types. On Line (c), describe any other limitations you wish to place on your representation. For example, if you wish to only authorize your representative to receive information, note this limitation on Line (c). Otherwise, your representative will not only be authorized to receive your confidential information but also full power to perform all acts necessary related to the subject matter of the indicated tax types and periods. If the box on Line (d) is not checked, the filing of this form will not revoke or otherwise invalidate any prior powers on file with the Department. If you check the box provided on Line (d), you will revoke all prior powers of attorney, unless the representatives are identified again in Section 2 of this form. If you are a representative that wishes to withdraw representation of a taxpayer, please forward a signed and dated letter with a copy of the POA you are withdrawing to the Department. SECTION 4 - SIGNATURE(S) The taxpayer is required to sign and date the POA. The completed and signed form DP-2848 POA must be filed with the Department by mail at the address above or by e-mailing the scanned document to POA@dra.nh.gov. NEED HELP? Call the Department of Revenue Administration, Taxpayer Services at (603) 230-5920. Individuals with hearing or speech impairments may call TDD Access: Relay NH 1-800-735-2964. DP-2848 Version 1 8 0 /2023 |