Il-2848 Power Of Attorney Page 2
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Copies of notices and other written communications addressed to the taxpayer in proceedings involving the matters listed on the front of
this form should be sent to the following:
Name
Name
Name
Street address
Street address
Street address
City
State
ZIP
City
State
ZIP
City
State
ZIP
(
)
(
)
(
)
Daytime phone number
Daytime phone number
Daytime phone number
Step 3: Taxpayer’s signature
If signing as a corporate offi cer, partner, fi duciary, or individual on behalf of the taxpayer, I certify that I have the authority to execute this
power of attorney on behalf of the taxpayer.
Taxpayer’s signature
Title, if applicable
Date
Spouse’s signature
Title, if applicable
Date
If corporation or partnership, signature of offi cer or partner
Title, if applicable
Date
Step 4: Complete the following if the power of attorney is granted to an attorney,
a certifi ed public accountant, or an enrolled agent
I declare that I am not currently under suspension or disbarment and that I am
a member in good standing of the bar of the highest court of the jurisdiction indicated below; or
duly qualifi ed to practice as a certifi ed public accountant in the jurisdiction indicated below; or
enrolled as an agent pursuant to the requirements of United States Treasury Department Circular Number 230.
Jurisdiction (state(s), etc.)
Designation (attorney, C.P.A., enrolled agent)
Signature
Date
Jurisdiction (state(s), etc.)
Designation (attorney, C.P.A., enrolled agent)
Signature
Date
Jurisdiction (state(s), etc.)
Designation (attorney, C.P.A., enrolled agent)
Signature
Date
Step 5: Complete the following if the power of attorney is granted to a person other
than an attorney, a certifi ed public accountant, or an enrolled agent
If the power of attorney is granted to a person other than an attorney, a certifi ed public accountant, or an enrolled agent, this document must
be witnessed or notarized below. Please check and complete one of the following.
Any person signing as or for the taxpayer
is known to and this document is signed in the presence of
the two disinterested witnesses whose signatures appear here.
Signature of witness
Date
Signature of witness
Date
appeared this day before a notary public and acknowledged
this power of attorney as his or her voluntary act and deed.
Notary seal
Signature of notary
Date
*965202110*
This form is authorized by the Illinois Tax Act. Disclosure of this information is REQUIRED. Failure to provide
information could result in a penalty. This form has been approved by the Forms Management Center. IL-492-0058
IL-2848 back (R-12/09)
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