Form 2848 Power of Attorney and Declaration of Representative

Form

2848

(Rev. October 2011)
Department of the Treasury
Internal Revenue Service

Part I

OMB No. 1545-0150

Power of Attorney
and Declaration of Representative
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Type or print.

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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

1 Taxpayer information. Taxpayer must sign and date this form on page 2, line 7.
Taxpayer name and address
Identifying number

Date

Daytime telephone number

/

/

Plan number (if applicable)

hereby appoints 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

Check if to be sent notices and communications

CAF No.
PTIN
Telephone No.
Fax No.
Check if new: Address

Telephone No.

Fax No.

Telephone No.

Fax No.

Telephone No.

Fax No.

CAF No.

Name and address

Check if to be sent notices and communications

PTIN
Telephone No.
Fax No.
Check if new: Address
CAF No.
PTIN

Name and address

Telephone No.
Fax No.
Check if new: Address
to represent the taxpayer before the Internal Revenue Service for the following matters:
3
Matters
Description of Matter (Income, Employment, Excise, Whistleblower,
PLR, FOIA, Civil Penalty, etc.) (see the instructions for line 3)

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

Year(s) or Period(s) (if applicable)
(see the instructions for line 3)

4

Specific use not recorded on Centralized Authorization File (CAF). If the power of attorney is for a specific use not recorded on CAF,
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check this box. See the instructions for Line 4. Specific Uses Not Recorded on CAF
. . . . . . . . . . . . . .

5

Acts authorized. Unless otherwise provided below, the representatives generally are authorized to receive and inspect confidential tax
information and to perform any and all acts that I can perform with respect to the tax matters described on line 3, for example, the authority to
sign any agreements, consents, or other documents. The representative(s), however, is (are) not authorized to receive or negotiate any
amounts paid to the client in connection with this representation (including refunds by either electronic means or paper checks). Additionally,
unless the appropriate box(es) below are checked, the representative(s) are not authorized to substitute another representative or add
additional representatives, to sign certain returns, or to execute a request for disclosure of tax returns or return information to a third party.
See the line 5 instructions for more information.
Disclosure to third parties;
Other

Signing a return;

Substitute or add representatives;
(see instructions for more information)

Exceptions. An unenrolled return preparer cannot sign any document for a taxpayer and may only represent taxpayers in limited situations.
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 agent may only represent taxpayers to the extent provided in section 10.3(e) of Circular 230. A registered tax
return preparer may only represent taxpayers to the extent provided in section 10.3(f) of Circular 230. See the line 5 instructions for restrictions
on tax matters partners. In most cases, the student practitioner’s (level k) authority is limited (for example, they may only practice under the
supervision of another practitioner).
List any specific deletions to the acts otherwise authorized in this power of attorney:

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

Cat. No. 11980J

Form 2848 (Rev. 10-2011)

Page 2

Form 2848 (Rev. 10-2011)

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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 matters and years or periods covered by 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.
Signature of taxpayer. If a tax matter concerns a year in which a joint return was filed, the husband and wife must each file a separate power
of attorney even if the same representative(s) is (are) being appointed. 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.

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

Signature

Print Name

Part II

Date

PIN Number

Title (if applicable)

Print name of taxpayer from line 1 if other than individual

Declaration of Representative

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 Circular 230 (31 CFR, Part 10), as amended, concerning practice before the Internal Revenue Service;
• I am authorized to represent the taxpayer identified in Part I for the 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 Circular 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 (for example, spouse, parent, child, grandparent, grandchild, step-parent, stepchild, 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 Internal Revenue Service is limited by section 10.3(d) of Circular 230).
h Unenrolled Return Preparer - Your authority to practice before the Internal Revenue Service is limited. You must have been eligible to sign the
return under examination and have signed the return. See Notice 2011-6 and Special rules for registered tax return preparers and unenrolled
return preparers in the instructions.
i Registered Tax Return Preparer—registered as a tax return preparer under the requirements of section 10.4 of Circular 230. Your authority to
practice before the Internal Revenue Service is limited. You must have been eligible to sign the return under examination and have signed the
return. See Notice 2011-6 and Special rules for registered tax return preparers and unenrolled return preparers in the instructions.
k Student Attorney or CPA—receives permission to practice before the IRS by virtue of his/her status as a law, business, or accounting student
working in LITC or STCP under section 10.7(d) of Circular 230. See instructions for Part II for additional information and requirements.
r Enrolled Retirement Plan Agent—enrolled as a retirement plan agent under the requirements of Circular 230 (the authority to practice before the
Internal Revenue Service is limited by section 10.3(e)).

IF THIS DECLARATION OF REPRESENTATIVE IS NOT SIGNED AND DATED, THE POWER OF ATTORNEY WILL BE
RETURNED. REPRESENTATIVES MUST SIGN IN THE ORDER LISTED IN LINE 2 ABOVE. See the instructions for Part II.

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Note: For designations d-f, enter your title, position, or relationship to the taxpayer in the "Licensing jurisdiction" column. See the instructions for Part II
for more information.

Designation—Insert
above letter (a–r)

Licensing jurisdiction
License/Bar or
(state) or other
Enrollment Number
licensing authority
(if applicable)
(if applicable)

Signature

Date

Form 2848 (Rev. 10-2011)