Form 2848 Draft - Power Of Attorney And Declaration Of Representative - 2011
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2Version A, Cycle 2
2848
Power of Attorney
OMB No. 1545-0150
Form
For IRS Use Only
and Declaration of Representative
(Rev. October 2011)
Received by:
Department of the Treasury
Type or print.
See the separate instructions.
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Internal Revenue Service
Name
Part I
Power of Attorney
Telephone
Caution: Form 2848 will not be honored for any purpose other than representation before the IRS.
Function
1 Taxpayer information. Taxpayer must sign and date this form on page 2, line 7.
/
/
Date
Identifying number
Taxpayer name and address
Daytime telephone number
Plan number (if applicable)
hereby appoints the following representative(s) as attorney(s)-in-fact:
2
Representative(s) must sign and date this form on page 2, Part II.
CAF No.
Name and address
PTIN
Telephone No.
Fax No.
Check if to be sent notices and communications
Check if new: Address
Telephone No.
Fax No.
CAF No.
Name and address
PTIN
Telephone No.
Fax No.
Check if to be sent notices and communications
Check if new: Address
Telephone No.
Fax No.
CAF No.
Name and address
DRAFT AS OF
PTIN
Telephone No.
Fax No.
Check if new: Address
Telephone No.
Fax No.
to represent the taxpayer before the Internal Revenue Service for the following matters:
October 17, 2011
3
Matters
Description of Matter (Income, Employment, Excise, Whistleblower,
Tax Form Number
Year(s) or Period(s) (if applicable)
PLR, FOIA, Civil Penalty, etc.) (see the instructions for line 3)
(1040, 941, 720, etc.) (if applicable)
(see the instructions for line 3)
4
Specific use not recorded on Centralized Authorization File (CAF). If the power of attorney is for a specific use not recorded on CAF,
check this box. See the instructions for Line 4. Specific Uses Not Recorded on CAF
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Acts authorized. Unless otherwise provided below, the representatives generally are authorized to receive and inspect confidential tax
information and to perform any and all acts that I can perform with respect to the tax matters described on Iine 3, for example, the authority to
sign any agreements, consents, or other documents. The representative(s), however, is (are) not authorized to receive or negotiate any
amounts paid to the client in connection with this representation (including refunds by either electronic means or paper checks). Additionally,
unless the appropriate box(es) below are checked, the representative(s) are not authorized to substitute another representative or add
additional representatives, to sign certain returns, or to execute a request for disclosure of tax returns or return information to a third party.
See the line 5 instructions for more information.
Disclosure to third parties;
Signing a return;
Substitute or add representatives;
(see instructions for more information)
Other
Exceptions. An unenrolled return preparer cannot sign any document for a taxpayer and may only represent taxpayers in limited situations.
An enrolled actuary may only represent taxpayers to the extent provided in section 10.3(d) of Treasury Department Circular No. 230 (Circular
230). An enrolled retirement plan agent may only represent taxpayers to the extent provided in section 10.3(e) of Circular 230. A registered tax
return preparer may only represent taxpayers to the extent provided in section 10.3(f) of Circular 230. See the line 5 instructions for restrictions
on tax matters partners. In most cases, the student practitioner’s (level k) authority is limited (for example, they may only practice under the
supervision of another practitioner).
List any specific deletions to the acts otherwise authorized in this power of attorney:
2848
For Privacy Act and Paperwork Reduction Act Notice, see the instructions.
Form
(Rev. 10-2011)
Cat. No. 11980J
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