Fillable Printable Power of Attorney Example - Hawaii
Fillable Printable Power of Attorney Example - Hawaii
Power of Attorney Example - Hawaii
1 Taxpayer Information. Taxpayer(s) must sign and date this form on page 2, line 6.
Taxpayer name(s) and address (Please type or print.)
Social security number(s) Federal employer
identification number
Daytime telephone number
Fax number
( )
( )
E-mail address
hereby appoint(s) the following representative(s) as attorney(s)-in-fact:
2 Representative(s) must be an individual and must sign and date this form on page 2, Part II.
Individual name and address Telephone No. ( )
Fax No. ( )
E-mail address
Check if new: Address Telephone Fax E-mail
Individual name and address Telephone No. ( )
Fax No. ( )
E-mail address
Check if new: Address Telephone Fax E-mail
Individual name and address Telephone No. ( )
Fax No. ( )
E-mail address
Check if new: Address Telephone Fax E-mail
Individual name and address Telephone No. ( )
Fax No. ( )
E-mail address
Check if new: Address Telephone Fax E-mail
to represent the taxpayer(s) before the Department of Taxation, State of Hawaii, for the following acts:
3 Acts authorized (you are required to complete this line 3). (Stating “All Taxes”, “All Forms”, or “All Periods” on line 3 is not acceptable.) With the
exception of the acts described in line 4b, I (we) authorize my (our) representative(s) to receive and inspect my (our) confidential tax information and to
perform acts that I (we) can perform with respect to the tax matters described below. For example, my (our) representative(s) shall have the authority to
sign any agreements, consents, tax clearance applications, or similar documents (but see instructions for authorizing a representative to sign a return).
Hawaii Tax I.D. Number Type of Tax Tax Form Number Year(s) or Period(s)
(Income, General Excise, etc.)
(N-11, N-13, G-49, etc.)
W __ __ __ __ __ __ __ __ - __ __
W __ __ __ __ __ __ __ __ - __ __
W __ __ __ __ __ __ __ __ - __ __
W __ __ __ __ __ __ __ __ - __ __
4a Additional acts authorized. In addition to the acts listed on line 3 above, I (we) authorize my (our) representative(s) to perform the following acts (see instructions):
Authorize disclosure to third parties; Substitute or add representative(s); Sign a return;
Other acts authorized:
4b Specific acts not authorized. My (our) representative(s) is (are) not authorized to endorse or otherwise negotiate any check (including directing or
accepting payment by any means, electronic or otherwise, into an account owned or controlled by the representative(s) or any firm or other entity with
whom the representative(s) is (are) associated) issued by the government in respect of a Hawaii tax liability.
List any specific deletions to the acts otherwise authorized in this power of attorney (see instructions):
FORM
N-848
(REV. 2014)
STATE OF HAWAII - DEPARTMENT OF TAXATION
POWER OF ATTORNEY
(NOTE: References to “married”, “unmarried”, and “spouse” also means
“in a civil union”, “not in a civil union”, and “civil union partner”, respectively.)
PART I POWER OF ATTORNEY (Please type or print.)
FORM N-848
Clear Form
FORM N-848
(REV. 2014) Page 2
5 Retention/Revocation of Prior Power(s) of Attorney. The filing of this power of attorney automatically revokes all earlier power(s) of attorney on
file with the State of Hawaii for the same tax matters and years or periods covered by this document. If you do not want to revoke a prior power of
attorney, check here ............................................................................................................................................................................................
YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT.
6 Signature of Taxpayer(s). If a tax matter concerns a year in which a joint return was filed, both spouses must sign if joint representation is
requested. If signed by a corporate officer, partner, guardian, tax matters partner/person, executor, receiver, administrator, or trustee on behalf of the
taxpayer, I certify that I have the authority to execute this form on behalf of the taxpayer.
IF NOT SIGNED AND DATED, THIS POWER OF ATTORNEY WILL BE RETURNED TO THE TAXPAYER.
Signature Date Title (if applicable)
Print Name Print name of taxpayer from line 1 if other than individual
Signature Date Title (if applicable)
Print Name
Social Security Number
(Last 4 numbers)
Type or Print Name Signature Date
PART II SIGNATURE OF REPRESENTATIVE(S)
Filing the Power of Attorney
File the original, photocopy, or facsimile transmission (fax) with each letter, request, form, or other document for which the power of attorney
is required. For example, if you wish to designate an individual to represent you in obtaining tax clearance certificates, a copy of Form
N-848 must be filed each time you submit Tax Clearance Applications. The Department does not maintain a permanent, centralized file of
powers of attorney.
