Form Ri-2848 - Power Of Attorney (Page 2 of 2) in pdf

Form Ri-2848 - Power Of Attorney Page 2

State of Rhode Island and Providence Plantations

Form RI-2848

14103988880102

Power of Attorney

This declaration must be completed by the attorney, certified public accountant, licensed public accountant, or enrolled agent.

I declare that I am not currently under suspension or disbarment from practice before the Division of Taxation and that:

I am a member in good standing of the bar of the highest court of the jurisdiction indicated below; or

I am duly qualified to practice as a certified public accountant in the jurisdiction indicated below; or

I am a licensed public accountant in the jurisdiction indicated below.

I am actively enrolled to practice before the Internal Revenue Service.

Designation

Jurisdiction

Signature

Date

(Attorney, CPA, LPA or enrolled agent)

(State, etc)

If the power of attorney is granted to a person other than an attorney, certified public accountant, or licensed public accountant, or enrolled

agent, it must be witnessed or notarized below.

The person (s) signing as or for the taxpayer (s): (Check and complete ONE.)

is/are known to and signed in the presence of the two disinterested witnesses whose signatures appear here:

Signature of witness

Date

Signature of witness

Date

appeared this day before a notary public and acknowledged this power of attorney as a voluntary act and deed

Signature of notary

Date

NOTARIAL SEAL

Form Ri-2848 - Power Of Attorney Page 2