(Rev. February 1993)

Form

2848

(Rev. February 1993)

Department of the Treasury

Internal Revenue Service

Part I

Power of Attorney

and Declaration of Representative

OMB No. 1545-0150

Expires 2-29-96

© For Paperwork Reduction and Privacy Act Notice, see the instructions.

Power of Attorney (Please type or print.)

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

Taxpayer name(s) and address

Social security number(s)

Employer identification

number

Plan number (if applicable)

Daytime telephone number

(

)

hereby appoint(s) the following representative(s) as attorney(s)-in-fact:

2 Representative(s) (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

Name and address

CAF No.

Telephone No. (

Fax No. (

)

Check if new: Address

)

Telephone No.

)

Telephone No.

Name and address

CAF No.

Telephone No. (

Fax No. (

)

Check if new: Address

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.)

4

5

Tax Form Number (1040, 941, 720, etc.)

)

Telephone No.

Year(s) or Period(s)

Specific Use Not Recorded on Centralized Authorization File (CAF).— If the power of attorney is for a specific use not

©

recorded on CAF, please check this box. (See Line 4—Specific Uses Not Recorded on CAF on page 3.)

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 in 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) or the power to sign certain returns (see Line 5—Acts Authorized on page 4).

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,

pr inted as Pub. 470, for more information.

Note: The tax matters partner/person of a partnership or S corporation is not per mitted to author ize 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 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) ©

Cat. No. 11980J

Form 2848 (Rev. 2-93)

Page 2

Form 2848 (Rev. 2-93)

7

Notices and Communications.—Notices and other written communications will be sent to the first representative listed

in line 2.

©

a If you also want the second representative listed to receive such notices and communications, check this box

©

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

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

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/person,

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.

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

Signature

Date

Title (if applicable)

Date

Title (if applicable)

Print Name

Signature

Print Name

Part II

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

230.

© If this declaration of representative is not signed and dated, the power of attorney will be returned.

Designation —Insert

above letter (a–h)

Jurisdiction (state) or

Enrollment Card No.

Signature

Date

Page 3

Form 2848 (Rev. 2-93)

Privacy Act and Paperwork Reduction 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 (SSN) or your employer

identification number (EIN). 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 min.; Learning about

the law or the form, 29 min.; Preparing the

form, 29 min.; Copying, assembling, and

sending the form to the IRS, 35 min.

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

form to either of these offices. Instead, see

Filing the Power of Attorney below.

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 II, Declaration of Representative,

items a–h. Any person who is not listed in

a–h of Part II 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, Tax

Information Authorization, 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,

get 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. 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, printed as Pub. 470,

Limited Practice Without Enrollment.

The power to sign tax returns can only be

granted in limited situations. See Line 5—

Acts Authorized on page 4 for more

information.

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.

Substitute Form 2848.—If you want to

prepare and use a substitute Form 2848, get

Pub. 1167, Substitute Printed,

Computer-Prepared, and

Computer-Generated Tax Forms and

Schedules. If your substitute Form 2848 is

approved, the form approval number must be

printed in the lower left margin of each

substitute Form 2848 you file with the IRS.

Specific Instructions

Part I—Power of Attorney

Line 1—Taxpayer Information.—

Individuals.—Enter your name, SSN

(and/or EIN, if applicable), and street address

in the space provided. If a joint return is

involved, and you and your spouse are

designating the same representative(s), also

enter your spouse’s name and SSN, and your

spouse’s address if different from yours.

Corporations, partnerships, or

associations.—Enter the name, EIN, 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, EIN

of the plan sponsor, three-digit plan number,

and business address of the sponsor.

Trust.—Enter the name, title, and address

of the trustee, and the name and EIN 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 EIN, if the estate has one, and the

decedent’s SSN.

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 the IRS will issue

one directly to your representative. The CAF

number is a unique nine-digit identification

number (not the SSN, EIN, 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/EO).

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 years or

period(s). For example, you may list “income

tax, Form 1040” for calendar year “1992” and

“Excise tax, Form 720” for the “1st, 2nd, 3rd,

and 4th quarters of 1992.” A general

reference to “All years,” “All periods,” or “All

taxes” is not acceptable. Any power of

attorney with such general reference will be

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

that can be recorded on the CAF 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 (i.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, the IRS records all powers

of attorney on the CAF system. However, a

power of attorney will not be recorded on the

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: (a) civil penalty issues,

(b) trust fund recovery penalty, (c) request for

a private letter ruling, (d) application for an

EIN, (e) claims filed on Form 843, Claim for

Refund and Request for Abatement,

Page 4

Form 2848 (Rev. 2-93)

(f) corporation dissolutions, (g) a request to

change accounting methods, and (h) a

request to change accounting periods. Check

the specific use box on line 4 if the power of

attorney is for a use that will not be listed on

the CAF. If the box on line 4 is checked, the

representative should bring a copy of

the power of attorney to each meeting with

the IRS. A specific use power of attorney will

not automatically revoke any prior powers of

attorney.

Line 5—Acts Authorized.—If you want to

modify the acts that your named

representative(s) can perform, 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 United

States (including Puerto Rico), for a period of

at least 60 days prior to the date required by

law for filing the return, or (c) specific

permission is requested of and granted by

the district director for other good cause.

If you want to authorize a person other

than a representative (an agent) to sign an

income tax return, you must

1. Complete the information on lines 1–3,

2. Check the box on line 4, and

3. Write the following on line 5:

“This power of attorney is being filed

pursuant to Regulation 1.6012(a)(5), reason

(a), (b), or (c), which requires a power of

attorney to be attached to a return if a return

is signed by an agent. No other acts on

behalf of the taxpayer are authorized.”

Reasons (a), (b), and (c) are defined above.

The agent does not complete Part II,

Declaration of Representative.

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: (a) 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; (b) 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 of a notice of final partnership

administrative adjustment or notice of final S

corporation administrative adjustment by the

IRS; (c) filing a request for administrative

adjustment on behalf of the partnership or S

corporation under sections 6227 and 6244;

(d) 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 (e) 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. The 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.

If this form is being filed for a private letter

ruling, the taxpayer can request that the

original letter ruling be sent to the

representative. A statement must be attached

to Form 2848 stating this.

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.

A representative can withdraw from

representation by filing a statement with each

office of the IRS where the power of attorney

was filed. The statement must be signed by

the representative and identify the name and

address of the taxpayer(s) and tax matter(s)

from which the representative is withdrawing.

Include your CAF No. on the statement if one

has been assigned to you.

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 has been

filed 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

has been filed 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.—All 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 a dissolved

corporation, deceased, insolvent, or 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 and

date 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 (i.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.

h Unenrolled Return Preparer—Enter the

two-letter abbreviation for the state (e.g.,

“KY” for Kentucky) in which the return

was prepared.