Form 2848 (Rev. 3-91)

Page 4

returned. You may list any tax years or
periods that have already ended as of the
date you sign the power of attorney.
However, the number of future tax periods
is limited to returns with due dates within 3
years of your signature on Form 2848. If the
matter relates to estate tax, enter the date
of the taxpayer's death instead of the year
or period. If the type of tax, tax form
number, or years or periods does not apply
to the matter (/.e., representation for a
penalty or filing a ruling request or
determination), specifically describe on this
line the matter to which the power of
attorney pertains and enter “Not
Applicable” in the appropriate column(s).
Line 4—Specific Uses Not Recorded on
CAF.—Generally, IRS records all powers of
attorney on the CAF system. However, a
power of attorney will not be recorded on
CAF if it does not relate to a specific tax
period or it is for a specific issue. Examples
of specific issues include but are not limited
to the following: (1) civil penalty issues, (2)
100% penalty, (3) request for a private
letter ruling, (4) application for an employer
identification number, (5) claims filed on
Form 843, Claim for Refund and Request
for Abatement, (6) corporate dissolutions,
(7) a request to change accounting
methods, and (8) a request to change
accounting periods. Check the specific use
box on line 4 if the power of attorney is fora
use that will not be listed on CAF. If the box
on line 4 is checked, the representative
should bring a copy of the power of attorney
to each meeting with IRS. A specific use
power of attorney will not automatically
revoke any prior powers of attorney.

Line 5—Acts Authorized.—f you want to
modify the acts that your named
representative(s) can perform, you should
describe any specific additions or deletions
in the space provided. The authority to
substitute another representative or
delegate authority must be specifically
stated on line 5.

If you want to authorize your
representative to sign an income tax return,
this authorization must be specifically listed
and the requirements of Regulations
section 1.6012-1(a)(5) must be satisfied. In
general, this regulation only permits a
representative to sign your return if you are
unable to make the return by reason of: (a)
disease or injury, (b) continuous absence
from the U.S. (including Puerto Rico) fora
period of at least 60 days prior to the date
required by law for filing the return, or (¢)
specific permission is requested of and
granted by the district director for other
good cause.

If any representative you name is an
unenrolled return preparer, the acts that
person can perform on your behalf are
limited by Revenue Procedure 81-38 (Pub.
470). In general, an unenrolled return
preparer is permitted to appear as your
representative only before revenue agents
and examining officers of the Examination
Division and the EP/EO Division and is not
permitted to represent you before other
offices (i.e., Collection Division or Appeals
Division) of the IRS. Also, an unenrolled
return preparer is not permitted to extend
the statutory period, execute waivers,
delegate authority, or substitute another
representative.

Tax Matters Partner/Person.—The tax
matters partner/person (TMP)(as defined in
sections 6231(a)(7) and 6244) is
authorized to perform various acts on behalf
of the partnership or S corporation. The
following are examples of acts performed by
the TMP that cannot be delegated to the
representative: (1) binding nonnotice
partners to a settlement agreement under
section 6224 and, under certain
circumstances, binding all partners or
shareholders to a settlement agreement
under Tax Court Rule 248; (2) filing a
petition for readjustment of partnership or
subchapter S items in the Tax Court, District
Court, or Claims Court, under sections
6226 and 6244, based on the issuance ofa
notice of final partnership administrative
adjustment or notice of final S corporation
administrative adjustment by the IRS; (3)
filing a request for administrative
adjustment on behalf of the partnership or
S corporation under sections 6227 and
6244; (4) filing a petition for adjustment of
partnership items with respect to an
administrative request in the Tax Court,
District Court, or Claims Court, under
sections 6228 and 6244; and (5) extending
the statute of limitations on assessment of
any tax attributable to partnership or
subchapter S items (and affected items)
under sections 6229 and 6244.

Line 6—Receipt of Refund Checks.—if
you want to authorize your representative to
receive, but not endorse, refund checks on
your behalf, you must initial and enter the
name of that person in the space provided.
Section 10.31 of Treasury Department
Circular No. 230 prohibits an attorney, CPA,
or enrolled agent, any of whom is an income
tax return preparer, from endorsing or
otherwise negotiating a tax refund check.

Line 7—Notices and Communications.—
Notices and other written communications
will be sent to the first representative listed.
Also, if you want the second representative
listed to receive such communications,
check box (a) on line 7. IRS will send
notices only to two representatives.
However, if you do not want any notices or
communications sent to your representative,
you must check box (b) on line 7.

Line 8—Retention/Revocation of Prior
Power(s) of Attorney.—If there is any
existing power(s) of attorney you do not want
to revoke, check the box on this line and
attach a copy of the power(s) of attorney.

If you want to revoke an existing power of
attorney and do not want to name a new
representative, send a copy of the
previously executed power of attorney to
each IRS office where the power of attorney
was filed. The copy of the power of attorney
must have a current signature of the
taxpayer under the signature already on line
9. Write “REVOKE” across the top of the
form. If you do not have a copy of the power
of attorney you want to revoke, send a
statement to each IRS office where you filed
the power of attorney. The statement of
revocation must indicate that the authority
of the power of attorney is revoked and
must be signed by the taxpayer. Also, the
name and address of each recognized
representative whose authority is revoked
must be listed.

The filing of a Form 2848 will not revoke
any Form 8821 that is in effect.
Line 9—Signature of Taxpayer(s).—

Individuals. —You must sign and date
the power of attorney. If a joint return is
used and both husband and wife will be
represented by the same individual(s), both
must sign the power of attorney unless one
spouse authorizes the other, in writing, to
sign for both. In that case, attach a copy of
the authorization. However, if a joint return
is used and husband and wife will be
represented by different individuals, each
taxpayer must execute his or her own power
of attorney on a separate Form 2848,

Corporations or associations.—An
officer having authority to bind the taxpayer
must sign. However, the tax matters person
may sign on behalf of an S corporation.

Partnerships.—A\l partners must sign
unless one partner is authorized to act in
the name of the partnership. A partner is
authorized to act in the name of the
partnership if, under state law, the partner
has authority to bind the partnership. A
copy of such authorization must be
attached. For purposes of executing Form
2848, the tax matters partner is authorized
to act in the name of the partnership. For
dissolved partnerships, see Regulations
section 601.503(c)(6).

Other. —If the taxpayer is: (1) a
dissolved corporation, (2) deceased,
(3) insolvent, or (4) a person for whom or by
whom a fiduciary (a trustee, guarantor,
receiver, executor, or administrator) has
been appointed, see Regulations section
601.503(d).

Part II—Declaration of Representative

The representative(s) you name must sign
this declaration and enter the designation
(i.e., items a-h) under which he or she is
authorized to practice before the IRS. In
addition, the representative(s) must list the
following in the “Jurisdiction” column:

a Attorney—Enter the two-letter
abbreviation for the state (e.g., “NY”
for New York) in which admitted to
practice.

b= Certified Public Accountant— Enter
the two-letter abbreviation for the state
(e.g., “CA” for California) in which
licensed to practice.

c¢ Enrolled Agent—Enter the enrollment
card number issued by the Director of
Practice.

d= Officer—Enter the title of the officer
(.e., President, Vice President, or
Secretary).

e Full-Time Employee—Enter title or
position (e.g., Comptroller or
Accountant).

f Family Member—Enter the
relationship to taxpayer (i.e., spouse,
parent, child, brother, or sister).

g Enrolled Actuary—Enter the enrollment
card number issued by the Joint Board
for the Enrollment of Actuaries.

hh Unenrolled Return Preparer— Enter
the two-letter abbreviation for the state
(e.g., “KY” for Kentucky) in which the
return was prepared.


rom 2848

OMB No, 1545-0150
(Rev. March 1991) Power of Attorney , 0. 5
Department ofthe Treasury and Declaration of Representative Expires 5-31-93
Internal Revenue Service > For Paperwork Reduction and Privacy Act Notice, see the instructions.
Power of Attorney
1 Taxpayer Information
Taxpayer name(s) and address (Please type or print.) Social security number(s) Employer identification
t t number
H H Plan number (if applicable)
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
Checkifnew: Address. . . CI TelephoneNo. ()
Name and address CAF No... _
Telephone No. (
Fax No. ( Deseeeee
Checkifnew: Address... [1] Telephone No. [1
Name and address CAF No. |.
Telephone No. ( )..
Fax No. ( )
Check ifnew: Address. . . [J TelephoneNo. C1

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 (1040, 941, 720, etc.) Year(s) or Period(s)

4 Specific Use Not Recorded on Centralized Authorization File (CAF).—If the power of attorney is fora specific us use not recorded on
CAF, please check this box. (See the instructions for Specific Use Not Recorded on CAF onpage4.) . . oe

5 Acts Authorized.—The representatives are authorized to receive and inspect confidential tax information and to perform any and all
acts that | can perform with respect to the tax matters described in line 3, for example, the authority to sign any agreements, consents,
or other sfocuments. The authority does not include the power to receive refund checks or the power to sign certain returns. (See
instructions.

List any specific additions or deletions to the acts otherwise authorized in this power of attorney: __

Note: /n 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 information.

Note: The tax matters partner/person of a partnership or S corporation is not permitted to authorize representatives to perform certain
acts. See the instructions for more information.

6 Receipt of Refund Checks.—If you want to authorize a representative named in line 2 to receive, BUT NOT TO ENDORSE OR CASH,
refund checks, initial here _m._._ and list the name of that representative below.

Name of representative to receive refund check(s) >

Cat. No. 119805 Form 2848 (Rev. 3-91)


Form 2848 (Rev. 3-91) Page 2

7 Notices and Communications.—Notices and other written communications will be sent to the first representative listed in line 2.
a If you want the second representative listed to receive such notices and communications, check thisbox . . . . . . 1 >
b Ifyou do not want any notices or communications sent to your representative, checkthisbox . . . ........>U1

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, checkhere . . . ee

YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN N 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/person, executor,
receiver, administrator, or trustee on behalf of the taxpayer, | certify that | have the authority to execute this form on behalf of the

taxpayer.
> If this power of attorney is not signed, it will be returned.

Signature Bate Title (if applicabiey

Print Name

Declaration of Representative

Under penalties of perjury, | declare that:
e | am not currently under suspension or disbarment from practice before the Internal Revenue Service;
@ | 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;
e | am authorized to represent the taxpayer(s) identified in Part | for the tax matter(s) specified there; and

@ lam one of the following:
a Attorney—a member in good standing of the bar of the highest court of the jurisdiction shown below.

Certified Public Accountant—duly qualified to practice as a certified public accountant in the jurisdiction shown below.

Enrolled Agent—enrolled as an agent under the requirements of Treasury Department Circular No. 230.

Officer—a bona fide officer of the taxpayer organization.

Full-Time Employee—a full-time employee of the taxpayer.

Family Member—a member of the taxpayer's immediate family (/.e., spouse, parent, child, brother, or sister).

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(a)(7) of Treasury Department Circular No. 230.

mmreaose

> If this power of attorney is not signed, it will be returned.

Designation —Insert | Jurisdiction (state) or
above letter (a—h) | Enrollment Card No. Signature Date



Form 2848 (Rev. 3-91)

Page 3

Paperwork Reduction and Privacy Act
Notice.—We ask for the information on
this form to carry out the Internal Revenue
laws of the United States. Form 2848 is
provided by the IRS for your convenience
and its use is voluntary. If you choose to
designate a representative to act on your
behalf, under section 6109 you must
disclose your social security number or your
employer identification number. The
principal purpose of this disclosure is to
secure proper identification of the taxpayer.
We also need this information to gain
access to your tax information in our files
and properly respond to your request. If you
do not disclose this information, the IRS
may suspend processing the power of
attorney and may not be able to fill your
request until you provide the number.

The time needed to complete and file this
form will vary depending on individual
circumstances. The estimated average time
is: Recordkeeping, 20 minutes; Learning
about the law or the form, 29 minutes;
Preparing the form, 29 minutes; Copying,
assembling, and sending the form to IRS,
35 minutes.

If you have comments concerning the
accuracy of these time estimates or
suggestions for making this form more
simple, we would be happy to hear from
you. You can write to both the Internal
Revenue Service, Washington, DC 20224,
Attention: IRS Reports Clearance Officer,
T:FP; and the Office of Management and
Budget, Paperwork Reduction Project
(1545-0150), Washington, DC 20503. DO
NOT send this tax form to either of these
offices. Instead, see the instructions below
for information on where to file.

Changes You Should Note.—Form 2848,
Power of Attorney and Declaration of
Representative, and Form 2848-D, Tax
Information Authorization and Declaration
of Representative, have been combined into
one form, Form 2848. Form 2848-D is now
obsolete and should no longer be used.
Unenrolled return preparers may now use
Form 2848; however, their practice before
the IRS is limited. See the instructions for
line 5 below. New Form 8821, Tax
Information Authorization, should be used
instead of Form 2848 to allow only
disclosure of tax information to a third
party.

General Instructions

(Section references are to the Internal
Revenue Code unless otherwise noted.)
Purpose of Form.—Form 2848 may be
used to grant authority to an individual to
represent you before the IRS and to receive
tax information. You may file this form
ONLY if you want to name a person(s) to
represent you and that person is a “person
recognized to practice before the Service.”
Persons recognized to practice before the
Service are listed in Part Il, Declaration of
Representative, items a-h.-Any person who
is not listed in a-h of Part Il is not authorized
to practice before the IRS under the
provisions of Treasury Department Circular
No. 230 and therefore cannot act as your
representative. However, you can use Form
8821 to authorize any person (or an
organization) to receive and inspect
confidential tax return information under

the provisions of section 6103. For
additional information about this or any
other matter concerning practice before the
IRS, please see Pub. 216, Conference and
Practice Requirements.

Fiduciaries.—A fiduciary (trustee,
executor, administrator, receiver, or
guardian) stands in the position of a
taxpayer and acts as the taxpayer.
Therefore, a fiduciary does not act as a
representative and should not file a power
of attorney to act as a representative. Form
56, Notice Concerning Fiduciary
Relationship, should be filed to notify the
IRS of the existence of a fiduciary
relationship. If a fiduciary wishes to
authorize an individual to represent or
perform certain acts on behalf of the entity,
a power of attorney must be filed and
signed by the fiduciary acting in the position
of the taxpayer.

Authority Granted.—This power of
attorney authorizes the individual(s) named
to perform any and all acts you can perform,
‘such as signing consents extending the time
to assess tax, recording the interview, or
executing waivers agreeing to a tax
adjustment. Delegating authority or
substituting another representative must be
specifically stated on line 5. However, the
authority granted to an unenrolled preparer
may not exceed that allowed under Revenue
Procedure 81-38. See Pub. 470, Limited
Practice Without Enrollment.

The power to sign tax returns can only be
granted in limited situations. See
Regulations section 1.6012-1(a)(5). The
power to receive refund checks must be
specified separately on line 6 of the form.
Additions or deletions to the authority to
perform any acts must be indicated on line
5 of the form.

Filing the Power of Attorney.—File the
original, photocopy, or facsimile
transmission (fax) of the power of attorney
with each IRS office with which you deal. If
you choose to file a power of attorney by
fax, you must first be sure that the
appropriate IRS office is equipped to accept
fax transmissions. If the power of attorney is
filed for a matter currently pending before
an office of the IRS, such as an
examination, file the power of attorney with
that office. Otherwise, file it with the service
center where the related return was, or will
be, filed. Refer to the instructions for the
related tax return for the service center
addresses.

Line-by-Line Instructions
Part I—Power of Attorney
Line 1—Taxpayer Information.—
Individuals. —Enter your name, social
security number (and/or employer
identification number, if applicable), and
street address in the space provided. If a
joint.return is used,.and you and your
spouse are designating the same
representative(s), also enter your spouse's
name and social security number, and your
spouse's address if different from yours.
Corporations, partnerships, or
associations. —Enter the name, employer
identification number, and business
address, If this form is being prepared for

corporations filing a consolidated tax return
(Form 1120), do not attach a list of
subsidiaries to this form. Only the parent
corporation information is required in line 1,
Also, line 3 should only list Form 1120 in
the Tax Form Number column. A subsidiary
must file its own Form 2848 for returns that
are required to be filed separately from the
consolidated return, such as Form 720,
Quarterly Federal Excise Tax Return, and
Form 941, Employer's Quarterly Federal
Tax Return.

Employee plan.—Enter the plan name,
employer identification number of the plan
sponsor, three-digit plan number, and
business address of the plan sponsor.

Trust.—Enter the name, title, and
address of the trustee, and the name and
employer identification number of the trust.

Estate. —Enter the name, title, and
address of the decedent's executor/
personal representative, and the name and
identification number of the estate. The
identification number for an estate includes
both the employer identification number, if
the estate has one, and the decedent's
social security number.

Line 2—Representative(s).—Enter the
name of your representative(s). Only
individuals may be named as
representatives. Please use the identical
name on all submissions. If you want to
name more than three representatives,
indicate so on this line and attach a list of
additional representatives to the form.

Enter the nine-digit Centralized
Authorization File (CAF) number for each
representative. If a CAF number has not
been assigned, enter “None,” and IRS will
issue one directly to your representative.
The CAF number is a unique nine-digit
identification number (not the social
security number, employer identification
number, or enrollment card number) that
the IRS assigns to representatives. The CAF
number is not an indication of authority to
practice. The representative should use the
assigned CAF number on all future powers
of attorney. CAF numbers will not be
assigned for employee plans and exempt
organizations application requests (EP/EQ).

Check the appropriate box to indicate if
either the address or telephone number is
new since a CAF number was assigned.
Enter your representative's fax telephone
number, if available.

If the representative is a former
employee of the Federal Government, he or
she must be aware of the post-employment
restrictions contained in 18 U.S.C., section
207 and in Treasury Department Circular
No. 230, section 10.26. Criminal penalties
are provided for violation of the statutory
restrictions, and the Director of Practice is
authorized to take disciplinary action
against the practitioner.

Line 3—Tax Matters.—Enter the type of
tax, the tax form number, and the year(s) or
period(s) (not to exceed 5 years). For
example, you may list “Income tax, Form
1040” for calendar year “1990” and
“Excise tax, Form 720” for the “1st, 2nd,
3rd, and 4th quarters of 1990.” A general
reference to “All years,” “All periods,” or
“All taxes” is not acceptable. Any power of
attorney with such general reference will be