14.
ACKNOWLEDGMENT,
WITNESSING, OR DECLARATION
(Complete 14a, 14b, or 14c)
14a
. ACKNOWLEDGMENT
The above-named person(s) signing as or for the principal(s)
appeared before me today and acknowledged this power of attorney
as his/her/their voluntary act and deed. The notarial seal must be
affixed unless a seal is not required under the laws of the state where
the power of attorney is executed.
Signature of Notary or Other Officer
Date Title
Signature of Witness Date
Signature of Witness Date
14b
. WITNESSING
This power of attorney was signed by or for the principal(s) by a person
or persons known to, and in the presence of, the two disinterested wit-
nesses whose signatures appear below:
NOTARIAL SEAL
(If required)
14c
. DECLARATION by attorney or certified public accountant who is granted the power of attorney by this form.
I declare that I am currently: (Check applicable box)
A member in good standing of the bar of the highest court of
1
Qualified to practice as a certified public accountant in
1
FOR TTB USE ONLY
DATE RECEIVED FOR FILING
TTB OFFICE
RECEIVED BY (Signature and Title)
INSTRUCTIONS
1.
GENERAL. This form is filed with TTB to show the appointed attorney
is to represent the principal.
2. ITEM 8. A full power of attorney is granted by paragraph 8(a). The power
of attorney may be limited or restricted by deleting all of paragraph 8(a)
and listing the specific powers to be conferred in section 8(b).
3.
EXECUTION. This form must be signed by or on behalf of the principal(s)
as follows:
(a) INDIVIDUAL by his or her completion of item 11.
(b)
(c)
ESTATE by completion of item 12 by the executor or administrator and
attaching other such documents as may be required by TTB.
4.
FILING. This form must be completed in duplicate, unless otherwise
required, and submitted to the Director, National Revenue Center,550
Main St., Ste. 8002, Cincinnati, OH 45202-5215. The original with any
attachments will be retained by the Director, National Revenue Center,
and all other copies will be returned to the principal. If the power of
attorney is applicable to more than one business establishment, additional
copies must be submitted for each.
5.
ORIGINAL OF A RULING. The Alcohol and Tobacco Tax and Trade
Bureau will give to an appointed attorney the original of a ruling
concerning the principal about TTB matters if a statement is made to
that effect in item 8(b).
6. REVOCATION. A power of attorney remains in effect until revoked by
the principal in written notice to the Director, National Revenue Center.
7.
RULES. All persons representing clients before the Alcohol and
Tobacco Tax and Trade Bureau must comply with the regulations
governing representation (26 CFR Part 601 or those regulations as
recodified in 27 CFR Part 71) and any other applicable rules and
statutes.
PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995.
The information collection is used by TTB to ensure that only duly
authorized individuals are signing documents. The information is voluntary.
The estimated average burden associated with this collection of information
is 30 minutes per respondent or recordkeeper, depending on individual
circumstances. Comments concerning the accuracy of this burden
estimate and suggestions for reducing this burden should be addressed to
the Reports Management Officer, Regulations and Rulings Division, Alcohol
and Tobacco Tax and Trade Bureau,1310 G St., NW, Box 12, Washington,
DC 20005.
An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a current, valid
OMB control number.
SignaturePrinted Name
The additional copies will be filed in the same manner as when the
power of attorney relates to only one establishment or business.
Copies reproduced by photographic process need not be certified as
copies of the original.
LIMITED LIABILITY COMPANY (LLC) by completion of item 12 by all
members or managers, or one member or manager who attaches his/
her authorization to act on behalf of the LLC.
Page 2 of 2
PARTNERSHIP, LIMITED LIABILITY PARTNERSHIP (LLP) by
completion of item 12 by all partners, or one partner who attaches
his/her authorization to act on behalf of all the partners unless this
authorization is provided by State law.
CORPORATION or ASSOCIATION by completion of items 12 and 13,
an officer authorized by supporting corporate or organizational
documents (preferably the president, vice-president, or treasurer; or
LLC member or manager), must sign in item 12.
1
Insert Name of State, Possession, or District of Columbia
(d)
(e)
Privacy Act Information
AUTHORITY. TTB requests the information on this form to carry out the requirements of the Internal Revenue Code of 1986 and the Federal Alcohol
Administration Act since signatures are required on various returns and other documents required by those laws. See, 26 U.S.C. 6061(a) and 27 U.S.C.
204(c). The provision of the information on this form is voluntary.
PURPOSES. TTB collects the information on this form to ensure that only duly authorized individuals are signing documents submitted to TTB and to
establish the extent of the designee’s authority.
ROUTINE USES. The information will be used by TTB to make determinations set forth in paragraph 2 above. TTB officers may disclose the information
to individuals to verify its accuracy where such disclosure is not prohibited by law. TTB officers may also disclose this information to other Federal, State,
foreign, or local law enforcement and regulatory agency personnel for purposes of enforcement of the laws of such other agencies where not otherwise
prohibited by law. The information may be disclosed to the Justice Department if the information appears to be false or misleading.
4. EFFECTS OF NOT SUPPLYING INFORMATION REQUESTED. Although the provision of the information on this form is voluntary, TTB may delay or
deny the approval of the form where information is not complete or missing.
5.
DISCLOSURE OF EMPLOYER IDENTIFICATION NUMBER AND SOCIAL SECURITY NUMBER. You do not have to supply these numbers. These
numbers are used to identify an individual or business. If you do not supply the numbers, however, processing may be delayed.
1.
2.
3.
TTB F 5000.8 (04/2016)
Date
