(Rev. October 2011) Department of the Treasury Internal Revenue Service
2848
Power of Attorney and Declaration of Representative
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OMB No. 1545-0150 For IRS Use Only Received by: Name Telephone Function Date
Type or print.
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See the separate instructions.
Part I
Power of Attorney
Caution: Form 2848 will not be honored for any purpose other than representation before the IRS.
1 Taxpayer information. Taxpayer must sign and date this form on page 2, line 7. Taxpayer name and address Identifying number
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Daytime telephone number 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. PTIN Telephone No. Fax No. Check if new: Address CAF No. PTIN Telephone No. Fax No. Check if new: Address CAF No. PTIN Telephone No. Fax No. Check if new: Address to represent the taxpayer before the Internal Revenue Service for the following matters: 3 Matters Description of Matter (Income, Employment, Excise, Whistleblower, PLR, FOIA, Civil Penalty, etc.) (see the instructions for line 3) Tax Form Number (1040, 941, 720, etc.) (if applicable) Name and address
Plan number (if applicable)
Check if to be sent notices and communications Name and address
Telephone No.
Fax No.
Check if to be sent notices and communications Name and address
Telephone No.
Fax No.
Telephone No.
Fax No.
Year(s) or Period(s) (if applicable) (see the instructions for line 3)
4 5
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 . . . . . . . . . . . . . . Acts authorized. Unless otherwise provided below, the representatives generally are authorized to receive and inspect
