rom 2848

(Rev. July 1976) Power of Attorney
Pagani Rtvenue Service (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)) (See Treasury Department Circular
No. 230 as amended (31 C.F.R. Part 10), Regulations Governing the Practice of Attorneys, Certified Public Accountants, and
Enrolled Agents before the Internal Revenue Service, for persons recognized to practice before the Internal Revenue Service.)

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

The attorney(s)-in-fact (or either of them) are authorized, subject to revocation, to receive confidential information and to
perform on behalf of the taxpayer(s) the following acts for 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) -..
Send copies of notices and other written communications addressed to the taxpayer(s) in proceedings involving the above
matters to (Name, address including ZIP code, and telephone number):

and

This power of attorney revokes. all earlier powers of attorney and tax information authorizations on file with the same Internal
Revenue Service office for the same matters and years or periods covered by this form, except the following:

(Specify to whom granted, date, and address inciuding ZIP code, or refer to aitached copies of earlier 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,

(The applicable portion of the back page must also be completed.) Form 2848 (Rev. 7-76)


Form 2848 (Rev. 7-76) 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

1 am aware of Treasury Department Circular No. 230 as amended (31 C.F.R. Part 10), Regulations Governing the Practice of
Attorneys, Certified Public Accountants, and Enrolled Agents before the Internal Revenue Service, and that:

| am a member in good standing of the bar of the highest court of the jurisdiction indicated below; or

1 am duly qualified to practice as a certified public accountant in the jurisdiction indicated below; or

I am enrolled as an agent pursuant to the requirements of Treasury Department Circular No. 230.

ignati Jurisdiction
Designation

‘State, ete.) i
(attorney, CPA or Enrollment Signature

or Agent) Card Number

Date

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. (See Treasury Department Circular No. 230 as amended (31 C.F.R. Part 10), Regulations
Governing the Practice of Attorneys, Certified Public Accountants, and Enrolled Agents before the Internal Revenue Service,
for persons recognized to practice before the Internal Revenue Service.)

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

(C1 is/are known to and signed in the presence of the two disinterested witnesses whose signatures appear here:

(Signature of Witness) ° (Date)

(Signature of Witness) " (Watey

DD appeared this day before a notary public and acknowledged this power of attorney as a voluntary act and deed.

NOTARIAL SEAL
(Date) (If required)

(Signature of Notary)