Form Ia 2848 - Iowa Power Of Attorney Form
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3Iowa Department of Revenue
Iowa Power of Attorney Form IA 2848
NOTE: A power of attorney may be effective for no more than three years from the date
Please type or print
it is received by the Department. 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.
1. TAXPAYER INFORMATION.
Last name or company legal 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
Daytime Telephone Number
City, State, ZIP
check if new telephone number
check if new address
2. REPRESENTATIVE(S). You must include Preparer’s Tax ID Number (PTIN), Federal Employer ID Number (FEIN),
or Social Security Number (SSN).
Name
PTIN, FEIN, OR SSN (MUST BE INCLUDED)
Firm or Company’s Legal Name
Telephone Number
check if new telephone number
Address
check if new 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
check if new telephone number
Address
check if new 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
check if new telephone number
Address
check if new 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). Attach a schedule for additional representatives.
Tax type and tax periods must be specifically identified. For inheritance, estate, or generation skipping tax, enter the
decedent’s date of death.
3. TAX MATTERS.
TAX PERIODS
List Type of Tax (see below for options) and the specific tax matter(s).
Beginning MM/YY
Ending MM/YY
TAX TYPE OPTIONS for section 3.
I ndividual Income
Partnership
Sales and Use
Inheritance
Motor Fuel
Corporation Income
Franchise
Withholding
Fiduciary
Environmental Protection Charge
Other (specify) _____________________________
14-101a (08/29/11)
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