Form 2848 Power of Attorney OMB No.

1545-0150
For IRS Use Only
(Rev. January 2002) and Declaration of Representative Received by:
Department of the Treasury
Internal Revenue Service 䊳 See the separate instructions. Name
Telephone
Part I Power of Attorney (Type or print.)
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

Daytime telephone number Plan number (if applicable)

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.
Name and address CAF No.
Telephone No.
Fax No.
Check if new: Address Telephone No.
Name and address CAF No.
Telephone No.
Fax No.
Check if new: Address Telephone 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
or Civil Penalty (See the instructions for line 3.) (1040, 941, 720, etc.) Period(s)

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. 䊳
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 Iine 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 authority to execute a request for a tax return, or a consent to
disclose tax information unless specifically added below, or the power to sign certain returns. See the instructions for Line
5. Acts authorized.
List any specific additions or deletions to the acts otherwise authorized in this power of attorney:

Note: In general, an unenrolled preparer of tax returns cannot sign any document for a taxpayer. See Revenue Procedure 81-38,
printed as Pub. 470, for more infor mation.
Note: The tax matters partner of a partnership is not permitted to authorize representatives to perform certain acts. See the separate
instructions for more infor mation.

6 Receipt of refund checks. If you want to authorize a representative named on Iine 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) 䊳

For Paperwork Reduction and Privacy Act Notice, see the separate instructions. Cat. No. 11980J Form 2848 (Rev. 1-2002)
Form 2848 (Rev. 1-2002) Page 2
7 Notices and communications. Original notices and other written communications will be sent to you and a copy to the
first representative listed on line 2 unless you check one or more of the boxes below.
a If you want the first representative listed on line 2 to receive the original, and yourself a copy, of such notices or
communications, check this box 䊳
b If you also want the second representative listed to receive a copy of such notices and communications, check this box 䊳
c If you do not want any notices or communications sent to your representative(s), check this box 䊳

8 Retention/revocation of prior power(s) of attorney. The filing of this power of attorney automatically revokes all earlier
power(s) of attorney on file with the Internal Revenue Service for the same tax matters and years or periods covered by
this document. If you do not want to revoke a prior power of attorney, check here 䊳
YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT.
9 Signature of taxpayer(s). If a tax matter concerns a joint return, both husband and wife must sign if joint representation is
requested, otherwise, see the instructions. If signed by a corporate officer, partner, guardian, tax matters partner, executor,
receiver, administrator, or trustee on behalf of the taxpayer, I certify that I have the authority to execute this form on behalf
of the taxpayer.
䊳 IF NOT SIGNED AND DATED, THIS POWER OF ATTORNEY WILL BE RETURNED.

Signature Date Title (if applicable)

Print Name

Signature Date Title (if applicable)

Print Name

Part II Declaration of Representative

Caution: Students with a special order to represent taxpayers in Qualified Low Income Taxpayer Clinics or the Student Tax Clinic
Program, see the separate instructions for Part II.
Under penalties of perjury, I declare that:
● I am not currently under suspension or disbarment from practice before the Internal Revenue Service;
● I am aware of regulations contained in Treasury Department Circular No. 230 (31 CFR, Part 10), as amended, concerning
the practice of attorneys, certified public accountants, enrolled agents, enrolled actuaries, and others;
● I am authorized to represent the taxpayer(s) identified in Part I for the tax matter(s) specified there; and
● I am one of the following:
a Attorney—a member in good standing of the bar of the highest court of the jurisdiction shown below.
b Certified Public Accountant—duly qualified to practice as a certified public accountant in the jurisdiction shown below.
c Enrolled Agent—enrolled as an agent under the requirements of Treasury Department Circular No. 230.
d Officer—a bona fide officer of the taxpayer’s organization.
e Full-Time Employee—a full-time employee of the taxpayer.
f Family Member—a member of the taxpayer’s immediate family (i.e., spouse, parent, child, brother, or sister).
g Enrolled Actuary—enrolled as an actuary by the Joint Board for the Enrollment of Actuaries under 29 U.S.C. 1242 (the
authority to practice before the Service is limited by section 10.3(d)(1) of Treasury Department Circular No. 230).
h Unenrolled Return Preparer—an unenrolled return preparer under section 10.7(c)(1)(viii) of Treasury Department Circular No. 230.
䊳 IF THIS DECLARATION OF REPRESENTATIVE IS NOT SIGNED AND DATED, THE POWER OF ATTORNEY WILL
BE RETURNED.

Designation—Insert Jurisdiction (state) or

Form 2848 (Rev. 1-2002)