Form 2848 Form 2848 Power of Attorney and Declaration of Representative

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I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 2848, PAGE 1 of 2
PRINTS: HEAD to HEAD
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 432 mm (17")
279 mm (11") Fold to 216 mm (8 1⁄2 ")
279 mm (11")
PERFORATE: (On Fold)

2848

(Rev. March 2004)
Department of the Treasury
Internal Revenue Service

Part I

Date

Revised proofs
requested

Power of Attorney
and Declaration of Representative
䊳

Type or print.

䊳

Signature

O.K. to print

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form

Action

OMB No. 1545-0150
For IRS Use Only
Received by:

See the separate instructions.

Name

Power of Attorney

Telephone

Caution: Form 2848 will not be honored for any purpose other than representation before the IRS.
Function
Date
1 Taxpayer information. Taxpayer(s) must sign and date this form on page 2, line 9.
/
/
Taxpayer name(s) and address
Social security number(s) Employer identification
number

Daytime telephone number

(

Plan number (if applicable)

)

hereby appoint(s) the following representative(s) as attorney(s)-in-fact:
2 Representative(s) must sign and date this form on page 2, Part II.
Name and address
CAF No.
Telephone No.
Fax No.
Check if new: Address
Name and address
CAF No.
Telephone No.
Fax No.
Check if new: Address

Telephone No.

Fax No.

Telephone No.

Fax No.

Name and address

CAF No.
Telephone No.
Fax No.
Check if new: Address
Telephone No.
to represent the taxpayer(s) before the Internal Revenue Service for the following tax matters:
3

4
5

Tax matters
Type of Tax (Income, Employment, Excise, etc.)
or Civil Penalty (see the instructions for line 3)

Tax Form Number
(1040, 941, 720, etc.)

Fax No.

Year(s) or Period(s)
(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
䊳
on CAF, check this box. See the instructions for Line 4. Specific uses not recorded on CAF.
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, 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.
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 2 of the instructions. An enrolled actuary may only represent
taxpayers to the extent provided in section 10.3(d) of Circular 230. See the line 5 instructions for restrictions on tax matters
partners.
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)

䊳

For Privacy Act and Paperwork Reduction Notice, see page 4 of the instructions.

Cat. No. 11980J

Form

2848

(Rev. 3-2004)

3
I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 2848, PAGE 2 of 2
PRINTS: HEAD to HEAD
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 432 mm (17")
279 mm (11"), Fold to 216 mm (81⁄2 ")
279 mm (11")
PERFORATE: (On Fold)

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 2848 (Rev. 3-2004)

Page

2

7

Notices and communications. Original notices and other written communications will be sent to you and a copy to the
first representative listed on line 2.
䊳
a If you also want the second representative listed to receive a copy of notices and communications, check this box
䊳
b If you do not want any notices or communications sent to your representative(s), check this box

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Retention/revocation of prior power(s) of attorney. The filing of this power of attorney automatically revokes all earlier
power(s) of attorney on file with the Internal Revenue Service for the same tax matters and years or periods covered by
䊳
this document. If you do not want to revoke a prior power of attorney, check here
YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT.

9

Signature of taxpayer(s). If a tax matter concerns a joint return, both husband and wife must sign if joint representation is
requested, otherwise, see the instructions. If signed by a corporate officer, partner, guardian, tax matters partner, executor,
receiver, administrator, or trustee on behalf of the taxpayer, I certify that I have the authority to execute this form on behalf
of the taxpayer.
䊳

IF NOT SIGNED AND DATED, THIS POWER OF ATTORNEY WILL BE RETURNED.

Signature

Date

PIN Number

Print Name

Signature

Print Name

Part II

Title (if applicable)

Print name of taxpayer from line 1 if other than individual

Date

Title (if applicable)

PIN Number

Declaration of Representative

Caution: Students with a special order to represent taxpayers in Qualified Low Income Taxpayer Clinics or the Student Tax Clinic
Program, see the instructions for Part II.
Under penalties of perjury, I declare that:
● I am not currently under suspension or disbarment from practice before the Internal Revenue Service;
● I am aware of regulations contained in Treasury Department Circular No. 230 (31 CFR, Part 10), as amended, concerning
the practice of attorneys, certified public accountants, enrolled agents, enrolled actuaries, and others;
● I am authorized to represent the taxpayer(s) identified in Part I for the tax matter(s) specified there; and
● I am one of the following:
a Attorney—a member in good standing of the bar of the highest court of the jurisdiction shown below.
b Certified Public Accountant—duly qualified to practice as a certified public accountant in the jurisdiction shown below.
c Enrolled Agent—enrolled as an agent under the requirements of Treasury Department Circular No. 230.
d Officer—a bona fide officer of the taxpayer’s organization.
e Full-Time Employee—a full-time employee of the taxpayer.
f Family Member—a member of the taxpayer’s immediate family (i.e., spouse, parent, child, brother, or sister).
g Enrolled Actuary—enrolled as an actuary by the Joint Board for the Enrollment of Actuaries under 29 U.S.C. 1242 (the
authority to practice before the Service is limited by section 10.3(d) of Treasury Department Circular No. 230).
h Unenrolled Return Preparer—the authority to practice before the Internal Revenue Service is limited by Treasury Department
Circular No. 230, section 10.7(c)(1)(viii). You must have prepared the return in question and the return must be under
examination by the IRS. See Unenrolled Return Preparer on page 2 of the instructions.
䊳

IF THIS DECLARATION OF REPRESENTATIVE IS NOT SIGNED AND DATED, THE POWER OF ATTORNEY WILL
BE RETURNED. See the Part II instructions.

Designation—Insert
above letter (a–h)

Jurisdiction (state) or
identification

Signature

Date

Form

2848

(Rev. 3-2004)