Form
2848
OMB No. 1545-0150
Power of Attorney
and Declaration of Representative
(Rev. June 2008)
Department of the Treasury
Internal Revenue Service
Power of Attorney
Taxpayer information. Taxpayer(s) must sign and date this form on page 2, line 9.
1
Employer identification
number
Social security number(s)
Taxpayer name(s) and address
Plan number (if applicable)
Daytime telephone number
hereby appoint(s) the following representative(s) as attorney(s)-in-fact:
Representative(s) must sign and date this form on page 2, Part II.
2
CAF No.
Name and address
Telephone No.
Fax No.
Telephone No.
Check if new: Address
Name and address
Telephone No.
Fax No.
Telephone No.
Check if new: Address
Name and address
Telephone No.
Fax No.
Telephone No.
Check if new: Address
to represent the taxpayer(s) before the Internal Revenue Service for the following tax matters:
Tax matters
3
Year(s) or Period(s)
(see the instructions for line 3)
Tax Form Number
(1040, 941, 720, etc.)
Type of Tax (Income, Employment, Excise, etc.)
or Civil Penalty (see the instructions for line 3)
Specific use not recorded on Centralized Authorization File (CAF). If the power of attorney is for a specific use not recorded on CAF,
check this box. See the instructions for Line 4. Specific Uses Not Recorded on CAF
©
4
Acts authorized. The representatives are authorized to receive and inspect confidential tax information and to perform any and all acts that
I (we) can perform with respect to the tax matters described on Iine 3, for example, the authority to sign any agreements, consents, or other
documents. The authority does not include the power to receive refund checks (see line 6 below), the power to substitute another representative
or add additional representatives, the power to sign certain returns, or the power to execute a request for disclosure of tax returns or return
information to a third party. See the line 5 instructions for more information.
5
List any specific additions or deletions to the acts otherwise authorized in this power of attorney:
6
Receipt of refund checks. If you want to authorize a representative named on Iine 2 to receive, BUT NOT TO ENDORSE OR CASH, refund
checks, initial here and list the name of that representative below.
Name of representative to receive refund check(s)
©
Cat. No. 11980J
Form 2848 (Rev. 6-2008)
Part I
Name
Telephone
Function
Date
For IRS Use Only
/
/
Received by:
For Privacy Act and Paperwork Reduction Act Notice, see page 4 of the instructions.
©
Type or print.
©
See the separate instructions.
( )
CAF No.
CAF No.
Caution: Form 2848 will not be honored for any purpose other than representation before the IRS.
Fax No.
Fax No.
Fax No.
Exceptions. An unenrolled return preparer cannot sign any document for a taxpayer and may only represent taxpayers in limited situations.
See Unenrolled Return Preparer on page 1 of the instructions. An enrolled actuary may only represent taxpayers to the extent provided in
section 10.3(d) of Treasury Department Circular No. 230 (Circular 230). An enrolled retirement plan administrator may only represent taxpayers
to the extent provided in section 10.3(e) of Circular 230. See the line 5 instructions for restrictions on tax matters partners. In most cases,
the student practitioner’s (levels k and l) authority is limited (for example, they may only practice under the supervision of another practitioner).
