Form Ia 2848 - Iowa Power Of Attorney Form
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Iowa Department of Revenue
IA 2848 Iowa Power of Attorney Form
NOTE: Failure to complete all requested information will result in this form not being
Please type or print
valid and will delay the effective date of the power of attorney.
1. TAXPAYER INFORMATION. Taxpayer(s) must sign and date this form on page 2, section 8.
Federal Employer Identification Number
Last name or company legal name
Your first name/middle initial
Social Security Number
•
State Tax Permit Number
Spouse’s last name
Spouse’s first name/middle initial
Social Security Number
•
Daytime Telephone Number
Current mailing address (number and street, apartment, lot or suite number) or PO Box
City, State, Zip
2. REPRESENTATIVE(S). You must include Preparer’s Tax ID Number (PTIN), Federal Employer ID Number (FEIN), or
Social Security Number (SSN). Attach a schedule for additional representatives.
Name
PTIN, FEIN, OR SSN (MUST BE INCLUDED)
Firm or Company’s Legal Name
Telephone Number
Address
Fax Number
City, State, Zip
E-Mail Address
Name
PTIN, FEIN, OR SSN (MUST BE INCLUDED)
Firm or Company’s Legal Name
Telephone Number
Address
Fax Number
City, State, Zip
E-Mail Address
Name
PTIN, FEIN, OR SSN (MUST BE INCLUDED)
Firm or Company’s Legal Name
Telephone Number
Address
Fax Number
City, State, Zip
E-Mail Address
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.
TAX PERIODS (required)
A power of attorney may be effective for no more than three years from
Tax type and tax periods must be specifically identified. For inheritance,
the date it is received by the Department.
estate, or generation skipping tax, enter the decedent’s date of death.
List Type of Tax (see below for options)
Iowa Tax Permit Number
Beginning MM/YY
Ending MM/YY
and the specific tax matter(s)
TAX TYPE OPTIONS. Enter tax type in section 3 above and include beginning and ending dates for each.
Individual Income
Partnership
Sales and Use
Inheritance
Motor Fuel
Corporation Income
Franchise
Withholding
Fiduciary
Environmental Protection Charge
Other (specify) _____________________________
14-101a (09/11/13)
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Parent category: Financial