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Form

2848

(Rev. Dec. 2015)
Department of the Treasury
Internal Revenue Service

Part I

1

OMB No. 1545-0150

Power of Attorney
and Declaration of Representative

For IRS Use Only
Received by:

Information about Form 2848 and its instructions is at www.irs.gov/form2848.

Name

Power of Attorney

Telephone

Caution: A separate Form 2848 must be completed for each taxpayer. Form 2848 will not be honored
for any purpose other than representation before the IRS.

Function
Date

/

/

Taxpayer information. Taxpayer must sign and date this form on page 2, line 7.

Taxpayer name and address

Taxpayer identification number(s)
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.

Name and address

Check if to be sent copies of notices and communications

CAF No.
PTIN
Telephone No.
Fax No.
Check if new: Address

Telephone No.

Fax No.

Telephone No.