Form 2848 Power of Attorney 

(Rev. March 2004) and Declaration of Representative

Department of the Treasury

Internal Revenue Service

Power of Attorney

1 Taxpayer information. Taxpayer(s) must sign and date this form on page 2, line 9.

Employe

number

Taxpayer name(s) and address Social security number(s)

Daytime telephone number Plan num

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.

Name and address

Telephone No.

Fax No.

Check if new: Address Telephone No.

Name and address

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

Year(s) o

(see the instru

Tax Form Number

(1040, 941, 720, etc.)

Type of Tax (Income, Employment, Excise, etc.)

or Civil Penalty (see the instructions for line 3)

Specific use not recorded on Centralized Authorization File (CAF). If the power of attorney is for a specifi

on CAF, check this box. See the instructions for Line 4. Specific uses not recorded on CAF. 

4

Acts authorized. The representatives are authorized to receive and inspect confidential tax information a

and all acts that I (we) can perform with respect to the tax matters described on Iine 3, for example, the au

agreements, consents, or other documents. The authority does not include the power to receive refund 

below), the power to substitute another representative, the power to sign certain returns, or the power to 

for disclosure of tax returns or return information to a third party. See the line 5 instructions for more infor

5

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 Iine 2 to receive, BUT NO

OR CASH, refund checks, initial here and list the name of that representative below.

Name of representative to receive refund check(s) 

Cat. No. 11980J Form 

Part I

Na

Tel

Fun

Da

Re

For Privacy Act and Paperwork Reduction Notice, see page 4 of the instructions.

 Type or print.  See the separate instructions.

( )

CAF No.

CAF No.

Caution: Form 2848 will not be honored for any purpose other than representation before the IRS.

Exceptions. An unenrolled return preparer cannot sign any document for a taxpayer and may only repre

limited situations. See Unenrolled Return Preparer on page 2 of the instructions. An enrolled actuary m

taxpayers to the extent provided in section 10.3(d) of Circular 230. See the line 5 instructions for restrictio

partners.
Form 2848 (Rev. 3-2004) 

7 Notices and communications. Original notices and other written communications will be sent to you and 

first representative listed on line 2.

If you also want the second representative listed to receive a copy of notices and communications, check th

b If you do not want any notices or communications sent to your representative(s), check this box 

8 Retention/revocation of prior power(s) of attorney. The filing of this power of attorney automatically rev

power(s) of attorney on file with the Internal Revenue Service for the same tax matters and years or perio

this document. If you do not want to revoke a prior power of attorney, check here 

YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT.

Signature of taxpayer(s). If a tax matter concerns a joint return, both husband and wife must sign if join

requested, otherwise, see the instructions. If signed by a corporate officer, partner, guardian, tax matters 

receiver, administrator, or trustee on behalf of the taxpayer, I certify that I have the authority to execute t

of the taxpayer.

9

 IF NOT SIGNED AND DATED, THIS POWER OF ATTORNEY WILL BE RETURNED.

Signature Date Title (if app

Print Name

Signature Date Title (if app

Print Name

Declaration of Representative

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 amend

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 jurisdictio

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 si

Enrolled Actuary—enrolled as an actuary by the Joint Board for the Enrollment of Actuaries under 29 U

authority to practice before the Service is limited by section 10.3(d) of Treasury Department Circular No

g

Unenrolled Return Preparer—the authority to practice before the Internal Revenue Service is limited by Treas

Circular No. 230, section 10.7(c)(1)(viii). You must have prepared the return in question and the return must b

examination by the IRS. See Unenrolled Return Preparer on page 2 of the instructions.

h

 IF THIS DECLARATION OF REPRESENTATIVE IS NOT SIGNED AND DATED, THE POWER OF ATTORNE

BE RETURNED. See the Part II instructions.

Jurisdiction (state) or

identification

Designation—Insert

above letter (a–h) Signature 

Part II

a

Form 

Caution: Students with a special order to represent taxpayers in Qualified Low Income Taxpayer Clinics or the S

Program, see the instructions for Part II.

PIN Number Print name of taxpayer from line 1 if othe

PIN Number