Form Sc2848 - Power Of Attorney And Declaration Of Representative - 2011
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1
2STATE OF SOUTH CAROLINA
1350
1350
DEPARTMENT OF REVENUE
SC2848
POWER OF ATTORNEY AND
(Rev. 12/1/11)
DECLARATION OF REPRESENTATIVE
3307
Part I
Power of Attorney
1
Taxpayer Information
(Note: Taxpayer(s) must sign and date this form on page 2, line 8.)
*
Social Security number(s)
*
Employer identification number
*
Taxpayer name(s) and address (Type or print.)
Plan number ( if applicable)
*
Daytime telephone number
Email Address
(
)
hereby appoint(s) the following representative(s) as attorney(s) - in fact:
2
Representative(s) (Type or print.)
*
Name and address of specific individual
*
Telephone No. (
)
Fax No. (
)
Check if new:
Address
Telephone No.
Name and address of specific individual
Telephone No. (
)
Fax No. (
)
Check if new:
Address
Telephone No.
Name and address of specific individual
Telephone No. (
)
Fax No. (
)
Check if new:
Address
Telephone No.
to represent the taxpayer(s) before the SC Department of Revenue for the following tax matters:
3
Tax Matters - A general reference to "All years," "All periods," or "All taxes" is not acceptable.
Year(s) or Period(s)
Type of Tax (Individual, Corporate, Withholding, Sales, etc.)
Tax Form Number (SC1040, WH1605, ST-3, etc.)
*
*
*
(See Line 3 instructions)
4
Acts Authorized - A representative is an individual authorized to receive and inspect confidential tax information
and to perform any and all acts on behalf of the taxpayer with respect to the tax matters described in line 3, including
the authority to sign any agreements, consents or other documents. You may not use a Power of Attorney form to
authorize a representative to receive refund checks. You may authorize a representative to sign a return ONLY as
set forth in South Carolina Code Section 12-2-75.
List any specific additions to or deletions from the acts otherwise authorized in this power of attorney:
5
Receipt of Refund Checks - If you want to authorize a representative named in line 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)
33071028
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