IRS Power of Attorney and Declaration of Representative
(Form 2848)
Part I – Power of Attorney
1. Taxpayer Information
Name
Taxpayer Identification Number
Address
Daytime Telephone Number
Plan Number (if applicable)
2. Representative(s)
Name and Address
CAF No.
PTIN/TIN
Telephone No.
Fax No.
3. Acts Authorized
Specific matters (if applicable)
4. Receipt of Refund Checks (if applicable, initial to authorize)
5. Notices and Communications
6. Retention/Revocation of Prior Power(s) of Attorney
Part II – Declaration of Representative
Designation–Insert above letter (a–r)
Licensing Jurisdiction (State) or Bar, License, Certification, Registration, or Enrollment Number
Signature and Date