Name of Taxpayer
Address (Street or Other Mailing Address)
City
Nebraska ID or Social Security Number
Zip CodeState
Business Name
Business Address (Street or Other Mailing Address)
City
Federal ID or Social Security Number
Zip CodeState
Name
Title or Firm Name
Name
Title or Firm Name
Zip CodeCity
Email Address (See Email in the instructions) Phone Number Email Address (See Email in the instructions) Phone Number
State
Address (Street or Other Mailing Address)
City
Zip CodeState
Address (Street or Other Mailing Address)
Attorney-in-fact’s Name and Address
(If more than two, see Designation of Attorney-in-fact in the instructions.)
Taxpayer’s Name and Address
The attorneys-in-fact designated on this form have the authority to receive condential information on behalf of the taxpayer and the
power to perform the following acts with respect to the tax matters designated above. Strike through any items for which this authority
is not granted.
• Fully represent the taxpayer in any hearing, determination, or appeal.
• Enter into any compromise with DOR.
• Execute waivers, including oers of waivers, of restrictions on assessment or collection of tax deciencies.
• Execute waivers of notice of disallowance of a claim for credit or refund.
• Execute consents extending the statutory period for issuing a notice of deciency determination.
• Receive, but not endorse or collect, checks in payment of any refund of taxes, penalties, or interest.
• Receive all notices and other written communications with respect to the taxpayer. If more than one attorney-in-fact is named,
enter name of the attorney-in-fact to receive these notices.
• Perform other acts, specically:
7-139-1978 Rev. 4-2022
Supersedes 7-139-1978 Rev. 12-2019
Date
Date
Title, If Applicable
Title, If Applicable
Signature
Print Name Email Address
Signature
Print Name Email Address
Power of Attorney
FORM
33
The taxpayer appoints the above attorneys-in-fact for purposes of duly authorized representation in any proceedings with the Nebraska
Department of Revenue (DOR) with respect to those tax categories, tax matters, and tax periods indicated below:
If signed by a corporate officer, partner, member, LLC manager, or fiduciary on behalf of the taxpayer, I hereby certify that I have the authority to execute
this Power of Attorney on behalf of the taxpayer.
Tax Matter of Representation
Tax Category Tax Period
sign
here
Revocation of Prior Powers of Attorney
A. I choose to revoke all prior powers of attorney on le with DOR with respect to the same tax matters, and tax periods listed above,
except the following:
B. I choose to revoke all prior powers of attorney on le with DOR.
You may fax this form to 402-471-5927, file this form electronically using ShareFile, or
mail this form to: Nebraska Department of Revenue, POBox94818, Lincoln, NE 68509-4818.
PRINT FORM
RESET FORM
Instructions
Who Must File. Any taxpayer who wishes to appoint
representation by another party in matters before the Nebraska
Department of Revenue (DOR) with regard to any tax imposed
by the tax laws of the State of Nebraska, must le a Power of
Attorney (POA), Form 33, or other appropriate POA. A POA
authorizes that party to receive condential tax information
regarding the taxpayer. The Form 33 is provided for the
taxpayer’s convenience in designating a POA, but it is not the
sole form which may be used. DOR will honor other properly
completed and signed POA authorizations.
When and Where to File. The completed Form 33 may be led
any time. This form, or another properly completed and signed
POA, must be led with DOR before any person designated
can represent the taxpayer in matters involving disclosure of
condential tax information. All POA’s must contain an original
signature of the individual with the authority to sign it. See Neb.
Rev. Rul. 99-20-1 for signature requirements.
This form, or other appropriate POA, may be led with DOR by
fax or mail; or by uploading a copy of the original electronically
with DOR using the state le sharing system (ShareFile) on
DOR’s website:
• Fax to 402-471-5927;
• Mail to the Nebraska Department of Revenue,
POBox94818, Lincoln, NE 68509-4818; or
• File electronically.
Taxpayer’s Name and Address. If the taxpayer is an
individual, a Social Security number must be listed. If a married,
ling jointly return was led, enter both spouses’ Social Security
numbers in the spaces provided.
If the taxpayer is a corporation, partnership, limited liability
company (LLC), or association, enter the name, state and federal
ID numbers (if applicable), and the business address. If the Form
33 will be used in a tax matter in the case of a pass-through entity
for which the names, addresses, and Social Security numbers or
ID numbers of the owners have not already been furnished to
DOR, these items should be listed on an attached sheet.
If the taxpayer is an estate or trust, enter the name, title, and
address of the duciary, as well as the name and ID number or
Social Security number of the taxpayer. If this space is used to
list other information, clearly label the change.
Designation of Attorney-in-fact. An attorney-in-fact is any
person or rm who is acting on behalf of another. Enter the
appropriate information pertaining to each person or rm to
whom representative authority and power is being delegated.
Space is provided for listing two appointees. If additional space
is required, attach a separate sheet clearly showing the names,
addresses, zip codes, email addresses, and phone numbers of
the additional appointees. The mailing address, email address,
and phone number listed on this form are permissible means of
communicating with the taxpayer.
If you wish to designate all members of a rm to act on your
behalf, enter “All members” under “Name.” Please enter the
rm name of the individual or rm.
Email. By entering an email address, the taxpayer acknowledges
that DOR may contact the taxpayer by email. The taxpayer
accepts any risk to condentiality associated with this method
of communication. DOR will send all condential information
by secure email or ShareFile. If you do not wish to be contacted
by email, write “Opt Out” on the line labeled “email address.”
Tax Category, Tax Matter, and Tax Period. F
orm 33 is
designed to clearly express the scope of the authority granted
by the taxpayer to any attorneys-in-fact. In the space provided,
designate all tax categories, tax matters, and tax periods for
which this Form 33 is being led. The scope of the authorization
granted must be clearly identied.
“Tax Category” requires a list of the type of tax, such as
“income” or “sales and use.” “Tax Matter of Representation”
requires a brief summary of the subjects for which the attorney-
in-fact will represent the taxpayer. These may include, but are
not limited to: tax assessment resulting from an audit; abatement
of penalty; claim for refund; or formal hearing. “Tax Period”
requires a designation of a specic year or time period. You may
list “all years” or “all periods.” As many as three entries may
be listed on one form.
Authorized Acts. The Form 33 lists several acts which can
be performed by the attorney-in-fact. This list is intended
to cover the most commonly appointed acts. If the taxpayer
does not wish to authorize the named attorney-in-fact to act or
receive information regarding a particular act which is listed, the
taxpayer must strike through any power which is not granted. This
is particularly important with respect to correspondence from
DOR to the taxpayer regarding the designated tax matters. If
the taxpayer wants to receive refund claim approvals or denials,
and other notices and written communications, rather than
have the attorney-in-fact be the recipient, strike through that
authorization. Otherwise, DOR will send notices and other
written communications to the designated attorney-in-fact.
Notices of deciency determination and amended notices will
always be mailed to the taxpayer directly even if a POA exists
for the taxpayer. A copy will be furnished to the designated
attorney-in-fact.
If the taxpayer wishes to authorize an act which is not listed, a
concise and specic statement about the additional authorization
must be made in the space provided, or a separate signed
statement may be attached to the Form 33.
Revocation of Prior Powers of Attorney. To revoke any
POAs previously led with DOR, choose Box A or B.
Box A. Checking this box allows the taxpayer the option of
revoking all POAs on le with DOR with the exception of those
listed on the lines provided (or on a list attached to the Form 33).
Check box A and list the names, addresses, and zip codes of the
attorneys-in-fact whose representative authority is not revoked.
The date of the earlier POA must also be listed. Copies of the
earlier POAs which are to remain in effect may be included
instead of the list. Be sure to sign the form.
Box B. Checking this box revokes all POAs previously led with
DOR. Check Box B, and sign the form.
If no boxes are checked, all prior POAs will remain in force.
Signature. The taxpayer must sign and date the form. If spouses
le a married, ling jointly income tax return, which both have
signed, then both spouses must sign the Form 33. If only one
spouse in a married couple signs Form 33, then a separate
Form33 must be completed and signed by the other spouse.
If only one spouse signs the POA, and there is no second POA
from the other spouse, then only the person designated by the
POA would be authorized to perform the acts authorized by the
POA. The nonsigning spouse who has led a joint return with
his or her spouse may still obtain information about, and may
discuss issues regarding, the couple’s joint return. However,
a person may not authorize another party, or themselves, to
receive condential tax information regarding separate returns
led by the person’s spouse.
If the taxpayer is a partnership, all partners must sign, unless
one is duly authorized to act in the name of the partnership.
Nebraska has adopted the Uniform Partnership Act of 1998
(
Neb. Rev. Stat. §§ 67-401 to 67-467) making each partner
a business agent duly authorized to act for any partnership
formed in Nebraska. Authorized signatures for nonresident
partnerships will be governed by the laws of the state in which
the partnership was formed.
If the taxpayer is a corporation or an association, an ofcer
having authority to bind the entity must sign. The ofcer must
indicate his or her ofcial title on the line provided.
If the taxpayer is a Nebraska LLC, then the Form 33 must be
signed by a member of the LLC. The validity of the authorizations
made by a foreign LLC will be determined governed by the laws
of the state in which the LLC wasorganized.
