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Fillable Printable Power of Attorney and Declaration of Representative - Maine

Fillable Printable Power of Attorney and Declaration of Representative - Maine

Power of Attorney and Declaration of Representative - Maine

Power of Attorney and Declaration of Representative - Maine

FORM
2848-ME
Power of Attorney and
Declaration of Representative
Maine Revenue Services
PO Box 1060
Augusta, ME 04332
Over
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 Identi 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 con dential information and to perform any and all
acts that the principal(s) can perform with respect to the above speci ed tax matter(s). List any speci c additions or deletions to the
acts otherwise authorized in this power of attorney: _________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
4 Notices and Communications. By 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 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 ling of this Power of Attorney automatically revokes all earlier power(s)
of attorney on 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 of cer, partner, or 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
____________________________________________ _________________________________________ _________________
Spouse Signature (if applicable) Title, if applicable Date
____________________________________________
Print Name
PART II Declaration of Representative
Under penalties of perjury, I declare that I am: (Circle one)
1. A member in good standing of the bar of the highest court of the jurisdiction shown below;
2. Duly quali ed to practice as a certi ed public accountant in the jurisdiction shown below;
3. An enrolled agent enrolled under U. S. Department of Treasury Circular 230;
4. A bona de of cer of the taxpayer’s organization;
5. A full-time employee of the taxpayer;
6. A member of the taxpayer’s immediate family (spouse, parent, child, brother or sister);
7. A duciary for the taxpayer;
8. Other (Explain) ______________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Designation Jurisdiction Signature Date
(insert appropriate (state, etc.)
number from list above)
Revised: October, 2013
IF THIS DECLARATION OF REPRESENTATIVE IS NOT SIGNED AND DATED,
THE POWER OF ATTORNEY WILL BE RETURNED.
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