Form Ia2848 - Iowa Power Of Attorney Form

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Iowa Department of Revenue
Iowa Power of Attorney Form IA2848
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
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).
N a m e
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
N a m e
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
N a m e
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
Type of Tax (see below for options)
Period(s)
MM/YY
to
MM/YY
Tax Type Options:
Periods must be specifically identified. For inheritance, estate, or generation skipping tax, enter the decedent’s date of death.
14-101a (06/20/03)

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