Power of Attorney OMB No, 1545-0150 (1991)

rom 2048

Power of Attorney OMB No, 1545-0150

(Rev. March 1991) . .

Department of the 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) Empioyer identification

t t number

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 CAF NO. oie eeceecennecececeeeccecweecence

Telephone No. ( ) ne

Fax No. ( ) cewnnccncwnceccecccccceccncccene

Check ifnew: Address . . . [LJ TelephoneNo. LI

Name and address CAF NO. ooo eeeeeeeececececncercececeeee

Telephone No. ( ) ne

Fax No. ( ) cncnnnccccnccnnccccecccucceceece

Check ifnew: Address. . . [1] TelephoneNo. [1

Name and address CAF NO. ooo eecceeeeeencecececeencenene

Telephone No. ( )

Fax No. ( ) eennnccecececnccneccccceecccene

Check ifnew: Address. . . LI] 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 for a specific use not recorded on

CAF, please check this box. (See the instructions for Specific Use Not Recordedon CAFonpage4.) ........ 2

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 documents. 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:

ee ee eee eee eee ere

[ee eee ee re ee eee eee eee ee ere eee eee eee eee er reer os

So SON we DEORE OOOO EE EAH EE EON HEHE EER SHAKES EH AS ONS EEEH SSH SE SDE SAR SEEMS E TASER EHS SH HE DEES SH ODED ORF OB eBDOB SPEC eT BBE SH HOHE BES HH BEEZ ED AM ER ROE

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 maiters 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 and list the name of that representative below.

Name of representative to receive refund check(s) »

Cat. No. 11980J 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, checkthisbox . . . . . ..>

b If you do not want any notices or communications sent to your representative, checkthisbox . . . . ra

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 . . . rs

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.

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iagia Declaration of Representative

Under penalties of perjury, | declare that:

e | am not currently under suspension or disbarment from practice before the Internal Revenue Service;

e | 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

e | am 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 (i.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,

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

mar on aoe

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 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 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. Ifa

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/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 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

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. lf 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) 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 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 (/.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 of a

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.

Aiso, 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.—!f 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, senda

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.—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. —|f 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

(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.