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Recent Changes OMB No. 1545-0150 Form 2848 (Rev. 3-2012) Page 2
Form (Rev. March 2012) 2848 Power of Attorney For IRS Use Only
Department of the Treasury and Declaration of Representative Received by: 6 toattorneyRetention/revocationrevokeona priorle withpowerthe Internalofofpriorattorney,Revenuepower(s)checkServiceofhere attorney..for the. same.The.lingmatters. of.this.andpower.years. of.orattorneyperiods. . .automaticallycovered. . .by this.revokes.document.. all.earlier.If.youpower(s). .do.notof. want
to Form 2848 Internal Revenue Service Type or print. See the separate instructions. Name YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT.
Part I Power of Attorney Telephone
Caution: A separate Form 2848 should be completed for each taxpayer. Form 2848 will not be honored Function
for any purpose other than representation before the IRS. Date / / 7 executor,ofSignatureattorneyreceiver,ofeventaxpayer.if theadministrator,sameIf a taxrepresentative(s)matteror trustee concernsonisbehalf(are)a yearbeingofinthewhichappointed.taxpayer,a jointIfreturnI certifysignedwasthatbyled,aI havecorporatethethehusbandauthorityofcer,andpartner,towifeexecutemustguardian,eachthis formletaxamattersseparateon behalfpartner,powerof the
• Joint lers must complete and submit separate Forms 2848 1 Taxpayer information. Taxpayer must sign and date this form on page 2, line 7. taxpayer.
Taxpayer name and address Taxpayer identication number(s) IF NOT SIGNED AND DATED, THIS POWER OF ATTORNEY WILL BE RETURNED TO THE TAXPAYER.
for the powers of attorney to be recorded on the Centralized Daytime telephone number Plan number (if applicable)
Authorization File. hereby appoints the following representative(s) as attorney(s)-in-fact: Signature Date Title (if applicable)
2 Representative(s) must sign and date this form on page 2, Part II.
Name and address CAF No.
PTIN
• Copies of notices and communications are no longer routinely Telephone No. Print Name PIN Number Print name of taxpayer from line 1 if other than individual
Check if to be sent notices and communications Check if new:FaxAddressNo. Telephone No. Fax No.
sent to the taxpayer’s representative. Taxpayers can “check Name and address CAF No. UnderPartpenaltiesII Declarationof perjury, I declareof Representativethat:
the boxes”, to have copies of notices and communications PTIN • I am not currently under suspension or disbarment from practice before the Internal Revenue Service;
Telephone No. • I am aware of regulations contained in Circular 230 (31 CFR, Part 10), as amended, concerning practice before the Internal Revenue Service;
sent to up to two representatives. Check if to be sent notices and communications Check if new:FaxAddressNo. Telephone No. Fax No. • I am authorized to represent the taxpayer identified in Part I for the matter(s) specified there; and
Name and address CAF No. • I am one of the following:
PTIN 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.
• The IRS no longer accepts taxpayer requests to have their Telephone No. c Enrolled Agent—enrolled as an agent under the requirements of Circular 230.
refund checks routinely sent to their representative. Check if new:FaxAddressNo. Telephone No. Fax No. d Officer—a bona fide officer of the taxpayer’s organization.
to represent3 Mattersthe taxpayer before the Internal Revenue Service for the following matters: e Full-Time Employee—a full-time employee of the taxpayer.
Description of Matter (Income, Employment, Payroll, Excise, Estate, Gift, Whistleblower, f child, brother, or sister). Family Member—a member of the taxpayer’s immediate family (for example, spouse, parent, child, grandparent, grandchild, step-parent, step-
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
• Registered Tax Return Preparers have been added to the list Practitioner Discipline, PLR, FOIA, Civil Penalty, etc.) (see instructions for(1040,line 3)941,Tax720,Formetc.)Number (if applicable) Year(s)(seeorinstructionsPeriod(s) (ifforapplicable)line 3) the Internal Revenue Service is limited by section 10.3(d) of Circular 230).
h Unenrolled Return Preparer—Your authority to practice before the Internal Revenue Service is limited. You must have been eligible to sign the
of individuals eligible to practice and will use designation returnreturnunderpreparersexamination in the instructions.and have signed the return. See Notice 2011-6 and Special rules for registered tax return preparers and unenrolled
level i. i Registeredpracticereturn. SeebeforeTaxNoticeReturnthe Internal2011-6Preparer—registeredRevenueand SpecialServicerulesas aistaxforlimited.returnregisteredYoupreparermusttaxhavereturnunderbeenthepreparersrequirementseligibleandto signunenrolledofthesectionreturn10.4returnunderofpreparersCircularexamination230.inandtheYourinstructions.haveauthoritysignedtothe
• Students who have received special permission to practice 4 checkSpecificthisusebox.notSeerecordedthe instructionson Centralizedfor LineAuthorization4.Specific UsesFile (CAF).Not RecordedIf theonpowerCAF of attorney. . is.for.a.specic. .use.not.recorded. . .on.CAF,. k StudentworkingAttorneyin LITC ororSTCPCPA—receivesunder sectionpermission10.7(d)toofpracticeCircularbefore230. Seethe IRSinstructionsby virtueforof his/herPart II forstatusadditionalas a law,informationbusiness,andor accountingrequirements.student
RETURNED. IF THIS DECLARATIONREPRESENTATIVESOF REPRESENTATIVEMUST SIGN IN THEIS NOTORDERSIGNEDLISTEDANDINDATED,LINE 2THEABOVE.POWERSeeOFtheATTORNEYinstructions forWILLPartBEII.
before the IRS will use designation level k. 5 orunlessinformationamountsActs signreturnanyauthorized.theagreements, informationpaidappropriateandtototheperformUnless clienttoconsents,box(es)a thirdinotherwise anyconnectionparty,belowandor other allsubstituteareprovided actswithchecked,documents. thatthisanotherbelow, I canrepresentationtheperformrepresentative(s)Therepresentativethe representative(s), representatives with(includingrespectorisadd(are)torefundsgenerally theadditionalhowever,nottaxauthorizedbymatterseitherare is representatives,(are) authorized electronicdescribedtonotexecuteauthorized meansto onorareceive linerequestsignor3,to certainpaperforreceive and forexample,disclosurechecks).taxinspect returns.or negotiatetheAdditionally,condential ofauthoritytax returnsanytotax r InternalEnrolledRevenueRetirementServicePlanisAgent—enrolledlimited by sectionas a retirement10.3(e)). plan agent under the requirements of Circular 230 (the authority to practice before the
Note: for more information. For designations d-f, enter your title, position, or relationship to the taxpayer in the "Licensing jurisdiction" column. See the instructions for Part II
Disclosure to third parties; Substitute or add representative(s); Signing a return; Bar, license, certication,
Other acts authorized: Licensing(state) orjurisdictionother registration,number (if applicable). or enrollment Signature Date
Helpful Hints (see instructions for more information) Designation—Insertletterabove(a–r) licensing(if applicable) authority See instructionsmore information.for Part II for
Exceptions. An unenrolled return preparer cannot sign any document for a taxpayer and may only represent taxpayers in limited situations.
for Preparing Form 2848 returnonsupervision230).AntaxenrolledAnpreparermattersenrolledactuaryof anotherpartners.mayretirementmayonlypractitioner).Inonlyrepresentmostplanrepresentcases,agenttaxpayersmaytaxpayersthe studentonlyto therepresenttopractitioner’sextentthe extentprovidedtaxpayersprovided(levelintosectionk)thein authoritysectionextent 10.3(f)providedis10.3(d)limitedof Circularofin(forTreasurysectionexample,230. See10.3(e)DepartmentthetheylineofmayCircular5Circularinstructionsonly practice230.No.Aforregistered230underrestrictions(Circularthetax
Line 1, Taxpayer Information – Provide all taxpayer information List any specic deletions to the acts otherwise authorized in this power of attorney:
readily available for identication, i.e., Taxpayer name, address, Form 2848 (Rev. 3-2012)
Social Security or Employer Identication Number(s),telephone For Privacy Act and Paperwork Reduction Act Notice, see the instructions. Cat. No. 11980J Form 2848 (Rev. 3-2012)
number and Employee Plan Number.
Line 2, Representative Information - Provide the representative
information, i.e., Representative name, address, telephone and
fax numbers, as well as the representative’s CAF number, if previ- Line 5, Acts Authorized – Provide or list any specic additions or dele- PART II - Declaration of Representative - Provide the correct
ously assigned. Check the appropriate boxes if the representative tions to the acts authorized to the representative(s) for the Form 2848. designation level of the representative (a, b, c, d, e, f, g, h, i, k, or
is to be sent notices and communications and/or the represen- Check boxes are provided for Disclosure to third parties, Substitute or r); licensing jurisdiction or other licensing authority; and bar, license,
tative’s information requires an update. Be sure to include the add representative(s) and Signing a return. certication, registration, or enrollment number. Designations level
representative’s PTIN, if applicable. h and i will provide their PTIN and level k will provide LITC or STCP,
Line 6, Retention/Revocation of prior Power(s) of Attorney – The as appropriate. The representative(s) must sign and date the Form
Line 3, Tax Matters – Provide type of tax matter, i.e., income, ling of a subsequent Form 2848 for previously led tax matters 2848. The number of days between the taxpayer and representative
employment, tax form number, i.e., 1040, 941, and year(s) or automatically revokes earlier power(s) of attorney on le. If you wish to signatures cannot exceed 45 days for domestic or 60 days for
period(s). A dash is acceptable in lieu of the word through, i.e. keep an existing Form 2848 in effect, check the box and attach a copy international unless the taxpayer signs after the representative.
2000-2009. Up to 3 future years may be submitted on Form of the Form 2848 you wish to remain in effect. Otherwise, all prior
2848; however, an Unenrolled Return Preparer or Registered Tax Forms 2848 will be removed.
Return Preparer cannot submit future year(s) or period(s).
Line 7, Signature of taxpayer – In order to receive representational
Line 4, Specic Use – Not recorded on the CAF database. authority, the taxpayer must sign and date the Form 2848.
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