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TA-105 (11/17) 
 
                                           New York State Division of Tax Appeals 
                                           Agency Building 1, Empire State Plaza, Albany, NY 12223 
                                           Power of Attorney 
 
Purpose:  This form is to be completed by a taxpayer who wishes to give one or more individuals the authority to represent you and to 
appear on your behalf in a Tax Appeals proceeding.  You may only appoint individuals (not a firm) to represent you. 
 
INSTRUCTIONS: 
 •  Please read instructions on page 3 before completing this form.  Attach additional sheet(s) as needed. 
 •  If not signed and dated (Section V, and Section VI if applicable), this Power of Attorney (POA) will not be processed. 
 
 Section I        Taxpayer Information 
 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 apt or suite number; or PO Box) City                                                                    State/Country (if applicable)           Zip Code 

 Telephone Number                                                        Email Address 

 Section II       Representative Information (special conditions may apply; see instructions) 
 Primary Individual Representative Name                                  Firm Name (if any) 

 Mailing Address (number and street with apt or suite number; or PO Box) City                                                                           State                            Zip Code 

 Telephone Number                                                        Email Address 

 Additional Individual Representative Name                               Firm Name (if any) 

 Mailing Address (number and street with apt or suite number; or PO Box) City                                                                           State                            Zip Code 

 Telephone Number                                                        Email Address 

 Additional Individual Representative Name                               Firm Name (if any) 

 Mailing Address (number and street with apt or suite number; or PO Box) City                                                                           State                            Zip Code 

 Telephone Number                                                        Email Address 

 Section III      Mailings 
 The Division of Tax Appeals will send copies of notices and other communications related to the matters authorized in Section IV to 
 the primary individual representative listed above.  If you prefer that they be sent to a different representative who has a POA on file 
 for the same matters, enter the individual’s name below. 
  
 Name of representative to receive copies of notices and other communications: __________________________________________ 
  
                                                                                                                                                                             Page  1of            3

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TA-105 (11/17) 
Page  2of  3
                                                     Power of Attorney 
 
 Section IV        Authority Granted 
 The taxpayer(s) named in Section I appoint(s) the individual(s) in Section II to act as their representative(s) with full authority to 
 receive confidential information and to perform any and all acts the taxpayer(s) can perform in connection with the following matters.  
 The appointed representative(s) will not have the authority to delegate their authority to another individual unless specifically 
 authorized below. 
 Mark all 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            
  Personal                                                                    (explain):     ___________________________________ 
    Income             

 Please list DTA number, if assigned, to which this POA may apply:  ___________________________________________ 
  
   I have other POAs on file for the specific matters identified above and want to revoke all of these other POAs. 

   I authorize the representative(s) in Section II to delegate his/her/their authority to another individual. 

 Section V         Taxpayer Signature 
 I certify, under penalty of perjury, that I am the taxpayer(s) named in Section I, 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 

 Signature                                               Print or Type Name (and Title if Applicable)                  Date 

 Section VI        Declaration of Representative(s) (to be completed by each representative) 
 I agree to represent the above named taxpayer(s) in accordance with this POA.  I affirm that my representation will not violate the 
 provisions of the Ethics in Government Act or the regulations promulgated thereunder.  I am (indicate all that apply in the 
 Designation(s) column below): 
                                                                             
 1  an attorney-at-law licensed to practice in New York State          4  an enrolled agent enrolled to practice before the Internal 
                                                                            Revenue Service 
 2  a certified public accountant duly qualified to practice in        5  an employee, not a corporate officer (if the taxpayer is a 
   New York State                                                           Corporation) 
 3  a public accountant enrolled with the New York State 
   Education Department                                                6  other:  ____________________________________________ 

 Designation(s)    Signature                                                     Print Name                            Date 
                                                                                                                        
Note:  Page  3of  3of this POA contains instructions for completion of this form and does not need to be included when submitted.

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TA-105 (11/17)
Page 3of 3
Power of Attorney
INSTRUCTIONS

General Information

Use this form for all matters before Tax Appeals, unless another period entered for all tax types. For tax periods other than
valid POA has been executed or is already on file with Tax calendar years, enter the beginning and ending dates for the
Appeals. Ifyou and your spouse filed a joint tax return but have periods. For taxes based on a specific transaction, enter the
different representatives, you must each file a separate POA. transaction date.

You do not need TA-105: Power of Attorney to authorize If your tax type is not listed, or if you are granting authority
someone who is already authorized to act for you (see 20 for a special assessment or fee administered by an agency,
NYCRR 3000.2 [a] [1] and [3]) or to authorize someone to mark “Other” and explain. To identify a specific audit case or
provide information for you. assessment, mark “ Other” and enter a case or assessment
ID number.
Only certain types of professionals may act on your behalf
before Tax Appeals. See Section VI and 20 NYCRR 3000.2 (a) All POAs already on file will remain in effect unless you
(2). indicate by checking the box that you wish to revoke such
other POAs.
Revocation and withdrawal - This POA will remain active
until you (the taxpayer) revoke it or your representative Section V - Taxpayer Signature
withdraws from representing you. Either revocation or You or someone who is authorized to act for you must sign and
withdrawal must be done in writing. Note: Representatives date this form. The authorized person may need to provide
may not revoke a POA. identification and evidence of authority to sign this POA.

Specific Instructions If a joint tax return was filed and both spouses will be
represented by the same representatives, both spouses must
Section I - Taxpayer Information sign and date this form unless one spouse authorizes the other,
The taxpayer identification number may be a social security in writing, to sign for both. In that case, attach a copy of the
number (SSN), employer identification number (EIN), individual authorization.
taxpayer identification number (ITIN) issued by the Internal
Revenue Service, or a tax identification number issued by the Section VI - Declaration of Representative(s)
NYS Tax Department. In the Designation(s) column, each representative must enter
the number(s) describing his/her profession or capacity to
Section II - Representative Information represent the taxpayer(s) listed on page 1 of this form. If the
You may use TA-105: Power of Attorney to appoint one or more representative enters “6” or “ other,” that representative must
representative(s). Your Primary Individual Representative will be indicate in the space provided his/her relationship or capacity to
mailed copies of notices and other communications unless you represent the taxpayer(s). If the representative is a professional
direct otherwise in Section III. If you are appointing more than but not licensed to practice in NYS, indicate in the space
two representatives, attach a sheet that provides all of the provided at number 6 the representative’s professional
information requested in Section II. The attached sheet must be designation and the state in which he/she is licensed, such as
signed and dated by each taxpayer named in Section I. “Florida Attorney.” If more than one representative is listed as

“other,” indicate the relationship or capacity for each
Caution: This POA cannot be partially revoked or withdrawn. If
representative by name. Each representative must sign and
you appoint more than one representative on this POA and later
date the declaration. If this declaration is not completed in its
choose to revoke one representative or one representative
entirety by each representative, the POA will be returned.
withdraws, the revocation or withdrawal will apply to all
Attach additional sheets if necessary.
representatives, and none will have ongoing authority to
represent you. You must file a new POA to appoint the An attorney, certified public accountant or licensed public
representatives that you want to continue representing you. accountant authorized to practice or licensed in any other

Section III - Mailings jurisdiction of the United States may appear and represent a
If you want copies of notices and other communications sent to petitioner for a particular matter after receiving special
someone other than the Primary Individual Representative listed permission from the Tribunal (see 20 NYCRR 3000.2 [a] [4]). A
in Section II of this POA, enter the name of that representative request for such permission shall be made in writing addressed
on the line provided. This representative must be someone who to:
is listed as a representative for the matters covered by this POA Secretary to the Tax Appeals Tribunal
on this or another valid POA on file. NYS Division of Tax Appeals
Agency Building 1, Empire State Plaza
If you do not want copies of notices and other communications Albany, NY 12223
sent to any representative, enter “None”.
Where to send TA-105: Power of Attorney
Section IV - Authority Granted
Use this section to specify the matters covered by this POA. By MAIL to: NYS Division of Tax Appeals
default, this POA will cover all tax types for all tax periods. Ifyou Agency Building 1, Empire State Plaza
select a tax type, but do not enter a tax period, this POA will Albany, NY 12223
cover the tax type selected for all tax periods. Ifyou enter a tax - or -
period, but do not select a tax type, this POA will cover the tax FAX to: (518) 272-5178

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