Il-2848-E - Power Of Attorney For Electronic Processing - Illinois Department Of Revenue - 1999

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Illinois Department of Revenue

IL-2848-E

Power of Attorney

for Electronic Processing

Read this information first

You must use this form if you are a designated agent ( e.g., service group, CPA, or other agent) who makes electronic tax payments to the

State of Illinois for your clients. This form is required only if your client did not provide an authorized signature on Form EFT-1,

Authorization Agreement for Electronic Funds Transfer. You must keep this form in your books and records and make it available to us if

we request.

Step 1: Taxpayer information

Business Taxpayer

Name

________________________________________________________________________________________________________

Business name

Owner’s name

Address ___________________________________________________________ FEIN

___ ___ - ___ ___ ___ ___ ___ ___ ___

Street

___________________________________________________________ IBT no.

___ ___ ___ ___ - ___ ___ ___ ___

City

State

ZIP

Individual Taxpayer

Name

________________________________________________________________________________________________________

First name and middle initial

Spouse’s first name and middle initial

Last name

Address ___________________________________________________________ SSN

___ ___ ___ - ___ ___ - ___ ___ ___ ___

Street

Primary SSN

___________________________________________________________ SSN

___ ___ ___ - ___ ___ - ___ ___ ___ ___

City

State

ZIP

Secondary SSN

Step 2: Designated agent information

Authorization is granted to the designated agent identified below to initiate electronic tax payments to the State of Illinois on our behalf.

Name

________________________________________________________________________________________________________

Designated agent’s business name

Designated agent’s name

Address ___________________________________________________________

____________________________________________

Street

Authorized designated agent’s signature

___________________________________________________________

____________________________________________

City

State

ZIP

Date

Step 3: Tax type or fee for participation

(Check all that apply.)

Authorization is granted to the designated agent identified above to initiate the following electronic tax payments to the State of Illinois on our behalf.

1 Corporate Income:

____ IL-1120-ES

____ IL-505-B

Elect. Dist. & Invested Capital:

____ ICT-1

____ ICT-4

Withholding Income:

____ IL-501

Revenue Gas:

____ RPU-50

____ RG-1

Individual Income:

____ IL-1040-ES

____ IL-505-I

Public Utilities:

____ RPU-50

____ RPU-13

Sales and Use:

____ RR-3

____ ST-1

Telecommunications Excise:

____ RPU-50

____ RT-2

5 Prepaid Sales:

____ PST-3

____ PST-1

Telecom. Infrastructure Maintenance:

____ RT-10

Step 4: Taxpayer’s signature

If signing as a corporate officer, partner, or fiduciary on behalf of the taxpayer, I certify that I have authority to execute this power of attorney.

________________________________________________________________________________________________________________

Taxpayer’s signature

Title

Date

________________________________________________________________________________________________________________

Signature for the taxpayer

Title

Date

This form is authorized by the Illinois Tax Act. Disclosure of this information is REQUIRED. Failure to provide this

information could result in a penalty. This form as been approved by the Forms Management Center.

IL-492-4101

IL-2848-E (N-4/99)