Form 2848a - Power Of Attorney And Declaration Of Representative
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A
D
R
LABAMA
EPARTMENT OF
EVENUE
FORM
Power of Attorney
2848A
Declaration of Representative
and
(REV. 10/05)
NOTE: If you have questions concerning the completion of this form, please refer to the instructions for Federal
Form 2848 (revised March 2004). Alabama Form 2848A is very similar to the federal form.
PART I – POWER OF ATTORNEY
1 TAXPAYER INFORMATION
TAXPAYER NAME(S) AND ADDRESS (Please Type or Print)
SOCIAL SECURITY NUMBER(S)
EMPLOYER IDENTIFICATION NUMBER
DAYTIME TELEPHONE NUMBER
(
)
Hereby appoint(s) the following representative(s) as attorney(s)-in-fact:
2 REPRESENTATIVE(S) (Please Type or Print)
NAME AND ADDRESS
TELEPHONE NUMBER
(
)
FAX NUMBER
(
)
NAME AND ADDRESS
TELEPHONE NUMBER
(
)
FAX NUMBER
(
)
NAME AND ADDRESS
TELEPHONE NUMBER
(
)
FAX NUMBER
(
)
To represent the taxpayer(s) before the Alabama Department of Revenue for the following tax matters:
3 TAX MATTERS
TYPE OF TAX (Individual, Corporate, Sales, etc.)
TAX FORM NUMBER (40, 20C, 41, 65, etc.)
YEAR(S) or PERIOD(S)
4 ACTS AUTHORIZED
The representative(s) are authorized to receive and inspect confidential tax information and to perform any and all acts that I (we)
can perform with respect to the tax matters described on line 3, (for example, the authority to sign any agreements, consents, or
other documents). The authority does not include the power to receive refund checks or the power to sign certain returns.
LIST ANY SPECIFIC ADDITIONS OR DELETIONS TO THE ACTS OTHERWISE AUTHORIZED IN THIS POWER OF ATTORNEY:
5 RECEIPT OF REFUND CHECKS
If you want to authorize a representative named on line 2 to receive, BUT NOT TO ENDORSE OR CASH, refund checks,
initial here ___________ and list the name of that representative below.
NAME OF REPRESENTATIVE TO RECEIVE REFUND CHECK(S)
FORM 2848A
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