rom 2848

(Rev. Aug. 1975) Power of Attorney
PeeaT Revenue Seance” (See the separate Instructions for Forms 2848 and 2848-D.)

Name, identifying number, and address including ZIP code of taxpayer(s)

hereby appoints (Name, address including ZIP code, and telephone number of appointee(s))

as attorney(s)-in-fact to represent the taxpayer(s) before any office of the Internal Revenue Service with respect to the following
Internal Revenue tax matters (specify the type(s) of tax and year(s) or period(s)):

Said attorney(s)-in-fact (or either of them) shall, subject to revocation, have authority to receive confidential information and
full power to perform on behalf of the taxpayer(s) the following acts with respect to the above tax matters:

(Strike through any of the following which are not granted.)

To receive, but not to endorse and collect, checks in payment of any refund of Internal Revenue taxes, penalties, or
interest. (See “Refund checks” on page 2 of the separate instructions.)

To execute waivers (including offers of waivers) of restrictions on assessment or collection of deficiencies in tax and
waivers of notice of disallowance of a claim for credit or refund.

To execute consents extending the statutory period for assessment or collection of taxes.

To execute closing agreements under section 7121 of the Internal Revenue Code.

To delegate authority or to substitute another representative.

Other acts (specify) . pescteneessee we
Copies of notices and other written communications addressed to the taxpayer(s) in proceedings involving the above matters
should be sent to (Name, address including ZIP code, and telephone number):

and

This power of attorney revokes all prior powers of attorney and tax information authorizations on file with the same Internal
Revenue office with respect to the same matters and years or periods covered by this instrument, except the following:

code, or refer to attached copies of prior powers and authorizations.)

Signature of or for taxpayer(s)

If signed by a corporate officer, partner, or fiduciary on behalf of the taxpayer, | certify that I have the authority to execute this
power of attorney on behalf of the taxpayer.

(Wate)

(The applicable portion of the back page must also be executed.) Form 2848 (Rev. 8-75)


Form 2848 (Rev. 8-75) Page 2

If the power of attorney is granted to an attorney, certified public accountant, or enrolled agent, this declaration must be
completed.

| declare that | am not currently under suspension or disbarment from practice before the Internal Revenue Service, that
| am aware of Treasury Department Circular No. 230 as amended (31 C.F.R. Part 10), and that:
1 am a member in good standing of the bar of the highest court of the jurisdiction indicated below; or
| am duly qualified to practice as a certified public accountant in the jurisdiction indicated below; or
1 am enrolled as an agent pursuant to the requirements of Treasury Department Circular No. 230.

, Jurisdiction
Designation

(Attorney, C.P.A., Ste ete Signature Date
or Agent) Card Number

If the power of attorney is granted to a person other than an attorney, certified public accountant, or enrolled agent, it must
be witnessed or notarized below.

The person(s) signing as or for the taxpayer(s): (Check and complete one.)

C1 issare known to and signed in the presence of the two disinterested witnesses whose signatures appear here:

(Signature of Witness) _ atey

‘Gignature of Witness) ” ate)

1 appeared this day before a notary public and acknowledged this power of attorney as his/her/their voluntary act and deed.

NOTARIAL SEAL
Wate) (If required)

‘x US, GOVERNMENT PRINTING OFFICE : 1975—-O-588-986 EI 430814328