Form M-5008-R - Appointment of Taxpayer Representative - New Jersey
Form M-5008-R (2-12) State of New Jersey Division of Taxation Page 1 of 2
APPOINTMENT OF TAXPAYER REPRESENTATIVE
(TYPE OR PRINT)
1. Taxpayer Information (if matter involves a joint income return, enter both names
if joint representation is requested).
Trusts: Enter the name and EIN of the trust, name and address of the trustee.
Estates: Enter the name and EIN of the estate, name and address of the executor or administrator.
Taxpayer’s Name Social Security number
Spouse’s/CU Partner’s Name Social Security number
Mailing Address
NJ Taxpayer ID number (if other than SS#)
City
State Zip
Name and Address of Trustee or Executor
Taxpayer is:
□ Individual (for an income or individual use tax return filed by that individual, or a joint income tax return
filed by the individual and his/her spouse/cu partner).
□ Corporation □ Partnership □ Sole Proprietorship
□ Estate □ Limited Liability Company □ Trust (other than a business trust)
□ Other: ___________
2. Representative Information (representative(s) must date and sign on page 2).
The taxpayer(s) named above hereby appoints the person(s) named below as his/her/their taxpayer
representative.
Name and Address Telephone Number:
Fax Number:
Representative ID:
Name and Address Telephone Number:
Fax Number:
Representative ID:
To represent the taxpayer(s) before the State for the following tax matter(s):
3. Tax Matters
□ All tax matters
□
Specific tax matters listed below:
Type of Tax (NJ Gross Income, Sales and Use, Corporate Business,
Employment, etc.)
Year(s) & Period(s)
4. Acts Authorized. The representative(s) is/are authorized to receive and inspect confidential tax
records and is/are granted full power to act with respect to the tax matters described in section 3 above, and to
do and perform all such acts as I could do or perform. The authority does not include the power to endorse a
refund check.
_________________________________ __________________ __________________________
Taxpayer Signature Date Title (if applicable)
_________________________________ __________________ __________________________
Taxpayer Signature Date Title (if applicable)
Page 1/4
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