Form D-2848 - Power Of Attorney And Declaration Of Representation - District Of Columbia
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2D-2848 Power of Attorney and
Government of the
District of Columbia
OFFICIAL USE ONLY
Declaration of Representation
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Personal information
Your first name, M.I., Last name for individual or Business name for business
Spouses first name, M.I., Last name for individual
Your SSN or EIN for business
Spouse’s SSN
Your daytime phone number
Home address (number and street) or business address
Apartment number
City
State
Zip code
hereby appoint(s) the following representative(s) as attorney(s)-in-fact:
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This Power of Attorney will not be valid unless the Representative(s) complete the
Representative(s)
Declaration of Represen-
, sign and date this form on page 2.
tative
Name and address
EIN/SSN
Telephone No.
Fax No.
E-mail address
Name and address
EIN/SSN
Telephone No.
Fax No.
E-mail address
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Tax matters
Type of Tax Income, Sales, etc
Tax Form
Years or Periods
Acts authorized The representatives are authorized to represent the taxpayer(s) before the Office of Tax and Revenue
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for the tax matters listed above, to receive and inspect confidential tax information and to perform any and all acts
that I (we) can perform (for example, the authority to sign any agreements, consents, or other documents). This
authority does not include the power to receive or cash refund checks. If you wish to grant this authority to your
authorized representative, please state this below. List any specific additions or deletions to the acts otherwise
authorized by this power of attorney:
Notices and communications Original notices and other written communications will be sent to you and a copy to
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the first representative listed unless you check the oval below.
If you do not want any notices or communications sent to your first representative, check here:
D-2848 Page 1
Revised 11/2005
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Parent category: Legal