Form 2848 - Power Of Attorney And Declaration Of Representative

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2848
Power of Attorney
OMB No. 1545-0150
Form
For IRS Use Only
and Declaration of Representative
(Rev. March 2004)
Received by:
Department of the Treasury
Type or print.
See the separate instructions.
Internal Revenue Service
Name
Power of Attorney
Telephone
Part I
Caution: Form 2848 will not be honored for any purpose other than representation before the IRS.
Function
1
Taxpayer information. Taxpayer(s) must sign and date this form on page 2, line 9.
/
/
Date
Taxpayer name(s) and address
Social security number(s)
Employer identification
number
Plan number (if applicable)
Daytime telephone number
hereby appoint(s) the following representative(s) as attorney(s)-in-fact:
2
Representative(s) must sign and date this form on page 2, Part II.
Name and address
CAF No.
Telephone No.
Fax No.
Check if new: Address
Telephone No.
Fax No.
Name and address
CAF No.
Telephone No.
Fax No.
Check if new: Address
Telephone No.
Fax No.
Name and address
CAF No.
Telephone No.
Fax No.
Check if new: Address
Telephone No.
Fax No.
to represent the taxpayer(s) before the Internal Revenue Service for the following tax matters:
3
Tax Matters
Type of Tax (Income, Employment, Excise, etc.)
Tax Form Number
Year(s) or Period(s)
or Civil Penalty (see the instructions for line 3)
(1040, 941, 720, etc.)
(see the instructions for line 3)
4
Specific use not recorded on Centralized Authorization File (CAF). If the power of attorney is for a specific use not recorded
.............
on CAF, check this box. See the instructions for Line 4. Specific uses not recorded on CAF.
5
Acts authorized. The representatives 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 (see line 6
below), the power to substitute another representative, the power to sign certain returns, or the power to execute a request
for disclosure of tax returns or return information to a third party. See the line 5 instructions for more information.
Exceptions. An unenrolled return preparer cannot sign any document for a taxpayer and may only represent taxpayers in
limited situations. See Unenrolled Return Preparer on page 2 of the instructions. An enrolled actuary may only represent
taxpayers to the extent provided in section 10.3(d) of Circular 230. See the line 5 instructions for restrictions on tax matters
partners.
List any specific additions or deletions to the acts otherwise authorized in this power of attorney:
6
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)
2848
For Privacy Act and Paperwork Reduction Notice, see page 4 of the instructions.
Form
(Rev. 3-2004)
DXA

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