Illinois Power Of Attorney For Administrative Hearing Proceedings
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Illinois Department of Revenue
Docket no. __________________
IL-2848-AH
Power of Attorney
For Administrative Hearing Proceedings
Read this information first
If you do not have a Form IL-2848, Power of Attorney, on file, you must file this original form, in person or by mail, with the Office of
Administrative Hearings. This form allows you to become the official representative of record for the identified protested tax matter and
to establish your authority to act on behalf of this taxpayer, receive notices, and file documents for the identified proceeding. You must
be an attorney to represent a taxpayer at an administrative hearing or other preliminary proceedings, including status calls and pretrial
conferences. Please type or print when completing this form and mail to one of our offices below.
OFFICE OF ADMINISTRATIVE HEARINGS (7-900)
OFFICE OF ADMINISTRATIVE HEARINGS (5-500)
ILLINOIS DEPARTMENT OF REVENUE
ILLINOIS DEPARTMENT OF REVENUE
100 W RANDOLPH ST
101 W JEFFERSON ST
CHICAGO IL 60601-3274
SPRINGFIELD IL 62794-9044
Step 1: Complete the following taxpayer information
1
4
Write all applicable taxpayer identification numbers.
Taxpayer’s name
IBT number
2
FEIN
Mailing address
SSN
3
Account number
City
State
ZIP
License number
Step 2: Complete the following representative information
5
11
Identify the type of protested item. (Check all that apply.)
Representative’s name
Assessment
Deficiency
6
Revocation
Penalty
Claim
Firm name, if applicable
Other
Type of protested item
7
Mailing address
a
Issue date of protested items
__ __ __ __ __ __ __ __
8
__ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __
City
State
ZIP
9
b
Periods covered
Phone number
Fax number
10
c
Identify the type of proceeding. (Check all that apply.)
Assessment or notice numbers, if any
Informal review
Hearing
(If needed, attach additional sheets to identify Items a, b, and c.)
Step 3: Taxpayer’s signature
I, the undersigned taxpayer, authorize the party identified in Step 2 to represent me with full power and authority at the identified
proceeding. I authorize all further notices and written documents, including confidential information, pertinent to this proceeding to be
sent to the representative’s address listed in Step 2. If signing as a corporate officer, partner, or fiduciary on behalf of the taxpayer, I
certify that I have the authority to execute this power of attorney on behalf of the taxpayer identified in Step 1.
Taxpayer’s signature
Title, if applicable
Date
Step 4: Representative’s signature
I, the undersigned, affirm that the taxpayer identified in Step 1 has authorized me as representative for the identified proceeding and
that I am an attorney, either
in good standing of the Illinois Bar; or
admitted (or am seeking admission) pro hac vice for this Illinois proceeding.
Printed name of representative
Jurisdiction or states
Representative’s signature
Date
This form is authorized by the Illinois Tax Act. Disclosure of this information is REQUIRED. Failure to provide
IL-2848-AH (R-12/99)
information could result in a penalty. This form has been approved by the Forms Management Center. IL-492-3871
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