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This is a FILL-IN format. Please do not handwrite any data on this form other than your signature.

             Government of the                   D-2848 Power of Attorney and                                      OFFICIAL USE ONLY
             District of Columbia
                                                 Declaration of Representation
      ▲ Personal Information
        Your first name, M.I., Last name for individual or Business name for business

        Spouse first name, M.I., Last name for individual

        Your SSN or EIN for business             Spouse’s SSN                                                   Your daytime phone number

        Home address (number and street) or business address                                                                             Apartment number

        City                                                                                             State     Zip code

        hereby appoint(s) the following representative(s) as attorney(s)-in-fact:
      ▲ Representative(s) This Power of Attorney will not be valid unless the Representative(s) complete the Declaration of Representative, sign and 
        date this form on page 2.
        Name and address                                                                          EIN/SSN
                                                                                                  PTIN
                                                                                                  Telephone Number 
                                                                                                  Fax No.
                                                                                                  E-mail Address
        Name and address                                                                          EIN/SSN
                                                                                                  PTIN
                                                                                                  Telephone Number 
                                                                                                  Fax No.
                                                                                                  E-mail Address
        Name and address                                                                          EIN/SSN
                                                                                                  PTIN
                                                                                                  Telephone Number
                                                                                                  Fax No.
                                                                                                  E-mail Address
        Name and address                                                                          EIN/SSN
                                                                                                  PTIN
                                                                                                  Telephone Number
                                                                                                  Fax No.
                                                                                                  E-mail Address
      ▲
        Tax Matters                                           Type Form                                            Years or Periods
        Type of Tax (Income, Sales, etc)

      ▲ Acts authorized
        The representatives are authorized to represent the taxpayer(s) before the Office of Tax and Revenue for the tax matters listed above, to receive and 
        inspect confidential tax information and to perform any and all acts that I (we) can perform (for example, the authority to sign any agreements, 
        consents, or other documents).  This authority does not include the power to receive or cash refund checks.  If you wish to grant this authority to your 
        authorized representative, please state this below.  List specific additions or deletions to the acts otherwise authorized by this power of attorney: 

        Revised 05/2015                                                                                            D-2848 Page 1

  Taxpayer's SSN or FEIN                        Taxpayer's Name

▲ Retention/revocation of prior power(s) of attorney By filing this power of attorney form, you automatically revoke all 
  earlier power(s) of attorney on file with the Office of Tax Revenue 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.
▲ Signatures
  Signature of taxpayer(s) If a tax matter concerns a joint return, both husband and wife must sign if joint 
  representation is requested.  If signed by a corporate officer, partner, guardian, tax matters partner, 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 other than the taxpayer, print the name here and sign below.

▲ Your Signature                                Date                         Title if other than individual

  Spouse's signature if filing jointly          Date                         Telephone number if other than the taxpayer

  If not signed and dated, this power of attorney will be returned
▲ Declaration of Representative Representative(s) must complete this section and sign below.

  Under penalties of perjury, I declare that:

  • As the authorized representative of the taxpayer(s) identified for the tax matter(s) specified herein; I am one of the
    following:
    a.  A member in good standing of the bar of the highest court of the jurisdiction shown below.
    b. A Certified Public Accountant duly qualified to practice in the jurisdiction shown below.
    c. An Enrolled Agent under the requirements of Treasury Department Circular # 230.
    d. A bona fide officer of the taxpayer’s organization.
    e. A full-time employee of the taxpayer, trust, receivership, guardian or estate.
    f. A member of the taxpayer’s immediate family (i.e., spouse, parent, child, brother, or sister).
    g. A general partner of a partnership.
    h. Student Attorney or CPA- receives permission to represent taxpayers before the IRS by virtue of his/her status as
    a law, business, or accounting student working in an L                   ow Income Taxpayer  linicC     or Student Tax  linic C rogramP .
    i.  Other

  Designation-   Licensing jurisdiction (state) Bar, license, certification, 
  Insert above   or other licensing authority   registration, or enrollment number 
  letter (a-i)     (if applicable)              (if applicable)                               Signature                             Date
▲

 If you have any questions regarding the Power of Attorney, contact the Office of Tax and Revenue, Customer Service Administration, 
 1101 4th Street, SW, Washington, DC 20024; or call (202) 727-4TAX (4829).

 Mail the original Power of Attorney to: 

                Office of Tax and Revenue, Customer Service Administration, PO Box 470, Washington, DC 20044-0470
                 If this declaration is not signed and dated, this power of attorney will be returned
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