New York State Department of Taxation and Finance
                                New York City Department of Finance
                                                                                                          POA-1(6/17)
                                Power of Attorney
Read instructions on the back before completing this form. For estate tax matters, use Form ET-14, Estate Tax Power of Attorney.
Filing Form POA-1 does not automatically revoke any previously filed powers of attorney (POAs), but may affect who receives mailings.
1.  Taxpayer information (taxpayers must sign and date this form in section 5)
 Taxpayer’s name                                                                                             Taxpayer’s identification number
 Spouse’s name (if you filed a joint tax return and both spouses are appointing the same representative)     Spouse’s SSN
 Mailing address (number and street with apartment or suite number, or PO Box)   City                                       State      ZIP code
 Country (if not United States)

2.  Representative information (special conditions may apply; see instructions)
 Primary individual representative name                                          Firm name (if any)                         Telephone number
 Mailing address (number and street with apartment or suite number, or PO Box)   City                                       State      ZIP code
 Country (if not United States)                                                                           Email address
 Title or profession (see instructions)                                                                   PTIN, SSN, or EIN            NYTPRIN (if applicable)
 Additional individual representative name                                       Firm name (if any)                         Telephone number
 Mailing address (number and street with apartment or suite number, or PO Box)   City                                       State      ZIP code
 Country (if not United States)                                                                           Email address
 Title or profession (see instructions)                                                                   PTIN, SSN, or EIN            NYTPRIN (if applicable)

3.  Mailings
 We will send copies of notices and other communications related to the matters authorized in section 4 to the primary individual representative 
 listed above. If you want them sent to a different representative who has a POA on file for the same matters, enter that individual’s name below.
 Name of representative to receive copies of notices and other communications:

4.  Authority granted
 The taxpayers named in section 1 appoint the individuals named in section 2 to act as their representatives with full authority to receive confidential 
 information and to perform any and all acts the taxpayers can perform, unless limited below, in connection with the following matters. Your appointed 
 representatives will not have the authority to sign tax returns or delegate their authority to another individual unless specifically authorized below.
 Mark an  Xin all boxes that apply. If this section is left blank, this POA will cover all tax types for all tax periods.
 Tax type                       Years, periods, or transaction                        Tax type                         Years, periods, or transaction
 All                                                                                  Sales and Use
 Corporation                                                                          Withholding
 Partnership/LLP/LLC                                                                  Other (explain):
 Personal Income
Mark an  Xin the box if this POA is for:    An offer in compromise (OIC) case
                                            A conciliation conference or Tax Appeals hearing
I want to limit the authority granted by this POA as follows (explain):  
I have other POAs on file for the specific matters identified above and want to revoke all of these other POAs  ...............................................................
I authorize the representatives in section 2 to do the following:
 Sign tax returns (including refund/credit applications) on my behalf                                     Delegate his/her/their authority to another individual
5.  Taxpayer signature
 I certify, under penalty of perjury, that I am the taxpayer named in section 1, or a corporate officer, partner (except a limited partner), member or 
 manager of a limited liability company, or fiduciary acting on behalf of the taxpayer, and that I have the authority to execute this POA.
 Signature                                                  Print or type name (and title, if applicable) Date                         Telephone number
         You must sign by hand
 Spouse’s signature (required if spouse listed in section 1)  Print or type name                          Date                         Telephone number
     Spouse must sign by hand
►  IF NOT SIGNED AND DATED, THIS POA WILL NOT BE PROCESSED.                                               See instructions on back for Where to send Form POA-1.

           02900106170094

POA-1 (6/17) (back)
                                                                 Instructions
General information                                                          Section 3 – Mailings
Use Form POA-1, Power of Attorney, when you want to give one or              If you want copies of notices and other communications sent to someone 
more individuals the authority to obligate or bind you, or appear on your    other than the primary individual representative listed in section 2 of this 
behalf. You may only appoint individuals (not a firm) to represent you.      POA, enter the name of that representative on the line provided. This 
Note: Authorizing someone to represent you does not relieve you of your      representative must be someone who is listed as a representative for the 
tax obligations.                                                             matters covered by this POA on this or another valid POA on file.
Use this form for all matters (except estate tax) imposed by the Tax         If you do not want copies of notices and other communications sent to 
Law or another statute administered by the New York State (NYS)              any representative, enter None.
Department of Taxation and Finance (Tax Department) and the New              Example: On 2/1/2016 you appoint Mr. Smith as your representative 
York City (NYC) Department of Finance. If you and your spouse filed a        for all tax matters for 2015. Mr. Smith will receive copies of mailings 
joint tax return but have different representatives, you must each file a    for these matters. On 8/15/2016, you appoint Ms. Jones as your 
separate Form POA-1.                                                         representative for all tax matters for 2015. Ms. Jones will now receive 
Unless you limit the authority you grant (see section 4), your appointed     copies of mailings for these matters. However, if you want Mr. Smith to 
representative will be authorized to perform any and all acts you can        continue to receive mailings, you must list Mr. Smith’s name in section 3 
perform, including but not limited to: receiving confidential information    of the POA appointing Ms. Jones. Ms. Jones will not receive mailings.
concerning your taxes, agreeing to extend the time to assess tax, and        Section 4 – Authority granted
agreeing to a tax adjustment.
                                                                             Use this section to specify the matters covered by this POA. By default, 
You do not need Form POA-1 to authorize someone to appear with you           this POA will cover all tax types for all tax periods. If you select a tax 
or with someone who is already authorized to act for you or to authorize     type, but do not enter a tax period, this POA will cover the tax type 
someone to provide information, or prepare a report or return for you.       selected for all tax periods. If you enter a tax period, but do not select a 
Only certain types of professionals may act on your behalf before the        tax type, this POA will cover the tax period entered for all tax types. For 
NYS Bureau of Conciliation and Mediation Services (BCMS), the NYC            tax periods other than calendar years, enter the beginning and ending 
Department of Finance Conciliation Bureau or at Tax Appeals. Visit the       dates for the periods. For taxes based on a specific transaction, enter 
Tax Department’s POA webpage (at www.tax.ny.gov/poa) for more                the transaction date.
information.                                                                 If your tax type is not listed, or if you are granting authority for a special 
Revocation and withdrawal – New: This POA willremain active until            assessment or fee administered by an agency, mark an  Xin the   Other 
you (the taxpayer) revoke it or your representative withdraws from           box and explain. To identify a specific audit case or assessment, mark 
representing you. Representatives may not revoke a POA.                      the Other box and enter a case or assessment ID number.
For information on ways to revoke a POA, or how a representative             If you want to limit your representative’s authority, explain the limitation. 
can withdraw, see the Tax Department’s POA webpage (at                       For example, you can limit your representative’s authority to only receive 
www.tax.ny.gov/poa).                                                         confidential information, but make no binding decisions for you. If you 
                                                                             need more space to explain the limitation, attach a sheet. The attached 
Specific instructions                                                        sheet must be signed and dated by each taxpayer named in section 1.
For additional information on how to complete Form POA-1, including          Section 5 – Taxpayer signature
who must sign as the taxpayer, visit the Tax Department’s POA webpage 
(at www.tax.ny.gov/poa).                                                     You or someone who is authorized to act for you must sign and date 
                                                                             Form POA-1. The authorized person who signs Form POA-1 may need 
Section 1 – Taxpayer information                                             to provide identification and evidence of authority to sign this POA.
The taxpayer identification number may be a social security number           If a joint tax return was filed and both spouses will be represented by the 
(SSN), employer identification number (EIN), individual taxpayer             same representatives, both spouses must sign and date Form POA-1 
identification number (ITIN) issued by the Internal Revenue Service, or a    unless one spouse authorizes the other, in writing, to sign for both. In 
tax identification number issued by the NYS Tax Department.                  that case, attach a copy of the authorization.
Section 2 – Representative information                                       Where to send Form POA-1
You may use Form POA-1 to appoint one or more representatives. Your          For matters administered by the NYS Tax Department:
Primary individual representative will be mailed copies of notices and 
other communications unless you direct otherwise in section 3. If you are    FAX to: (518) 435-8617 (the easiest and fastest method)
appointing more than two representatives, attach a sheet that provides       Mail to: NYS TAX DEPARTMENT 
all of the information requested in section 2. The attached sheet must be             POA CENTRAL
signed and dated by each taxpayer named in section 1.                                 W A HARRIMAN CAMPUS
                                                                                      ALBANY NY 12227-0864
Caution: This POA cannot be partially revoked or withdrawn. If you 
appoint more than one representative on this POA and later choose            See Publication 55, Designated Private Delivery Services, if not  
to revoke one representative or one representative withdraws, the            using U.S. Mail.
revocation or withdrawal will apply to all representatives, and none will    For matters administered by NYC Department of Finance, send to the 
have ongoing authority to represent you. You must file a new POA to          office in which the matter is pending.
appoint the representatives that you want to continue representing you.
All representatives are deemed as authorized to act separately unless        Privacy notification
you explain that all representatives are required to act jointly on the line New York State Law requires all government agencies that maintain a 
in section 4 that allows you to limit the authority granted by this POA.     system of records to provide notification of the legal authority for any 
                                                                             request for personal information, the principal purpose(s) for which the 
For each appointed representative, enter the title or profession or, if      information is to be collected, and where it will be maintained. To view 
your representative is not a professional, enter the representative’s        this information, visit our website at www.tax.ny.gov, or, if you do not 
relationship to you. If the representative is not licensed in NYS, also      have Internet access, call (518) 457-5431 and request Publication 54, 
include the state where licensed (for example, Florida attorney). Enter      Privacy Notification.
each representative’s federal preparer tax identification number (PTIN), 
SSN, or EIN. If applicable, also enter each representative’s New York tax    The Commissioner of the New York City Department of Finance 
preparer registration identification number (NYTPRIN).                       is authorized to require disclosure of identifying numbers by 
                                                                             section 11-102.1 of the Administrative Code of the City of New York.

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