Form Ia2848 - Iowa Power Of Attorney
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Iowa Department of Revenue
Iowa Power of Attorney Form IA2848
NOTE: Failure to complete all requested information will result in this form not being valid and will delay the effective date of the Power of
Attorney.
Please type or print
1. TAXPAYER INFORMATION. Taxpayer(s) must sign and date this form on page 2, section 8.
•
Last name or company name
Your first name/middle initial
Social Security Number
Federal Employer Identification Number
•
Spouse’s last name
Spouse’s first name/middle initial
Social Security Number
State Tax Permit Number
Current mailing address (number and street, apartment, lot or suite number) or PO Box
Daytime Telephone Number
City, State, ZIP
check if new telephone number
check if new address
2. REPRESENTATIVE(S).
Name
PTIN, FEIN, OR SSN (MUST BE INCLUDED)
Address
Telephone Number
City, State, ZIP
Fax Number
E-Mail Address
check if new address
check if new telephone number
Name
PTIN, FEIN, OR SSN (MUST BE INCLUDED)
Address
Telephone Number
City, State, ZIP
Fax Number
E-Mail Address
check if new address
check if new telephone number
Name
PTIN, FEIN, OR SSN (MUST BE INCLUDED)
Address
Telephone Number
City, State, ZIP
Fax Number
E-Mail Address
check if new address
check if new telephone number
The above representatives are hereby appointed as attorney(s)-in-fact to represent the taxpayer(s) before the Iowa Department of
Revenue for the following tax matter(s):
3. TAX MATTERS.
BEGINNING
ENDING
List Type of Tax (see below for options) and the specific tax matter(s).
Period(s)
MM/YY
to
MM/YY
Tax Type Options:
Individual Income
Fiduciary
Corporation Income
MVF, EPC
Inheritance
Franchise
Withholding
Partnership
Sales and Use
Other (specify) ________________________________
Periods must be specifically identified. For inheritance, estate, or generation skipping tax, enter the decedent’s date of death.
14-101a (08/19/05)
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