Name of Taxpayer
Address (Street or Other Mailing Address)
Nebraska ID or Social Security Number
Zip CodeState
Business Name
Business Address (Street or Other Mailing Address)
Federal ID or Social Security Number
Zip CodeState
Title or Firm 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
Address (Street or Other Mailing Address)
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 condential information on behalf of the taxpayer and the
power to perform the following acts with respect to the designated tax matters. Strike through any items which will not be granted.
Fully represent the taxpayer in any hearing, determination, or appeal.
Enter into any compromise with DOR.
Execute waivers, including offers of waivers, of restrictions on assessment or collection of tax deciencies.
Execute waivers of notice of disallowance of a claim for credit or refund.
Execute consents extending the statutory period for issuing a notice of deciency 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, specically:
7-139-1978 Rev. 12-2019
Supersedes 7-139-1978 Rev. 4-2018
Title, If Applicable
Title, If Applicable
Print Name Email Address
Print Name Email Address
Power of Attorney
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
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 powers of attorney on le with DOR.
You may fax this form to 402-471-5927.
Mail this form to: Nebraska Department of Revenue, POBox94818, Lincoln, NE 68509-4818.
Who Must File. Any taxpayer who wishes to secure
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 condential 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 all 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 condential tax information.
This form, or other appropriate POA, may be faxed or mailed
to DOR:
Fax to 402-471-5927; or
Mail to the Nebraska Department of Revenue,
POBox94818, Lincoln, NE 68509-4818.
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, 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 partnership for which the names,
addresses, and Social Security numbers or ID numbers 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 who is acting on behalf of another. Enter the
appropriate information pertaining to each person 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, 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.
Email. By entering an email address, the taxpayer
acknowledges that DOR may contact the taxpayer by email.
The taxpayer accepts any risk to condentiality associated with
this method of communication. DOR will send all condential
information by secure email or the State of Nebraska’s le
share system. 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 authorization granted
must be clearly identied.
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 specic year or time
period. Reference can be made to “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 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 deciency
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 specic 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 Form 33 must be signed by the other spouse. If
there is only one spousal signature or a second POA is not
signed, 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
condential tax information regarding separate returns led
by the person’s spouse.
Only certain people may represent a taxpayer in a contested
case once a hearing ofcer is appointed: (1) the taxpayer;
(2) a Nebraska attorney; or (3) a non-Nebraska attorney
in good standing who partners with a Nebraska lawyer in
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 ofcer
having authority to bind the entity must sign. The ofcer must
indicate his or her ofcial title on the line provided.
If the taxpayer is a Nebraska limited liability company (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 was organized.