IRS Power of Attorney and Declaration of Representative

In the case of wanting to allow another person to represent you with the IRS in the State of Kentucky, the following form has to be completed and submitted.

Extracted Text for Proper Search

Form   	2848	
Department of the Treasury  
Internal Revenue Service (Rev. Dec. 2015) 	
Power of Attorney 
and Declaration of Representative 	
 ▶ Information about Form 2848 and its instructions is at www.irs.gov/form2848.	
OMB No. 1545-0150 
For IRS Use Only 
Received by: 
Name 
Telephone 
Function 
Date              	/      / 	
Part I 	Power of Attorney     
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. 	
1	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-fa\
ct: 	
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. 	
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. 	
Name and address
(Note: IRS sends notices and communications to only two representatives.)	
CAF No. 
PTIN
Telephone No. 
Fax No. 	
Check if new: Address 	Telephone No. 	Fax No. 	
Name and address
(Note: IRS sends notices and communications to only two representatives.)	
CAF No. 
PTIN
Telephone No. 
Fax No. 	
Check if new: Address 	Telephone No. 	Fax No. 
to represent the taxpayer before the Internal Revenue Service and perfor\
m the following acts: 3	
Acts authorized (you ar e requir ed to complete this line 3).  With the exception of the acts described in line 5b, I authorize my r epresentative(s) to r eceive and 
inspect my confidential tax information and to perform acts that I can p\
erform with r espect to the tax matters described below. For example, my representative(s) 
shall have the authority to sign any agr eements, consents, or similar documents (see instructions for line 5a f\
or authorizing a r epresentative to sign a r eturn).	
Description of Matter (Income, Employment, Payroll, Excise, Estate, Gif\
t, Whistleblower, 
Practitioner Discipline, PLR, FOIA, Civil Penalty, Sec. 5000A Shared Res\
ponsibility Payment, Sec. 4980H Shared Responsibility Payment, etc.) (see instruct\
ions) 	Tax Form Number  
(1040, 941, 720, etc.) (if applicable) 	Year(s) or Period(s) (if applicable)  (see instructions) 	
4 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 Use Not Recorded on CAF  ...............  	▶	
5a 
Additional acts authorized. In addition to the acts listed on line 3 above, I authorize my represent\
ative(s) to perform the following acts (see 
instructions for line 5a for more information):	
Authorize disclosure to third parties;	Substitute or add representative(s);	Sign a return;	
Other acts authorized:	
For Privacy Act and Paperwork Reduction Act Notice, see the instructions\
. 	Cat. No. 11980J 	Form 	2848	 (Rev.12-2015)

Form 2848 (Rev. 12-2015)	Page 	2 	
b  Specific acts not authorized. My representative(s) is (are) not authorized to endorse or otherwise\
 negotiate any check (including directing or 
accepting payment by any means, electronic or otherwise, into an account\
 owned or controlled by the representative(s) or any firm or other 
entity with whom the representative(s) is (are) associated) issued \
by the government in respect of a federal tax liability.	
List any other specific deletions to the acts otherwise authorized in th\
is power of attorney (see instructions for line 5b): 	
6 Retention/revocation  of prior  power(s)  of attorney.  The filing  of this  power  of attorney  automatically  revokes all earlier  power(s)  of 
attorney  on file  with  the Internal  Revenue  Service for the  same  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 EF\
FECT. 	
7	Signature  of taxpayer.  If a tax  matter  concerns  a year  in which  a joint  return  was filed,  each  spouse  must file a separate  power of attorney  even 
if  they  are appointing  the same  representative(s).  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 legal autho\
rity to execute this form on behalf of the taxpayer. 
▶ IF NOT COMPLETED, SIGNED, AND DATED, THE IRS WILL RETURN THIS POWER OF A\
TTORNEY TO THE TAXPAYER.	 	
Signature	 	Date 	Title (if applicable) 	
Print Name	Print name of taxpayer from line 1 if other than individual 	
Part II 	Declaration of Representative 	
 Under penalties of perjury, by my signature below I declare that: 
• I am not currently suspended or disbarred from practice, or ineligi\
ble for practice, before the Internal Revenue Service;
• I am subject to regulations contained in Circular 230 (31 CFR, Sub\
title A, Part 10), as amended, governing practice before the Internal R\
evenue Service;
• I am authorized to represent the taxpayer identified in Part I for \
the matter(s) specified there; and 
• I am one of the following: 
a  Attorney—a member in good standing of the bar of the highest court of\
 the jurisdiction shown below. 
b  Certified Public Accountant—licensed to practice as a certified publi\
c accountant is active in the jurisdiction shown below. 
c  Enrolled Agent—enrolled as an agent by the Internal Revenue Service p\
er the requirements of Circular 230. 
d  Officer—a bona fide officer of the taxpayer organization. 
e  Full-Time Employee—a full-time employee of the taxpayer. 
f   Family Member—a member of the taxpayer’s immediate family (spouse\
, parent, child, grandparent, grandchild, step-parent, step-child, broth\
er, or sister). 
g  Enrolled Actuary—enrolled as an actuary by the Joint Board for the En\
rollment of Actuaries under 29 U.S.C. 1242 (the authority to practice b\
efore  the Internal Revenue Service is limited by section 10.3(d) of Circular\
 230). 
h  Unenrolled Return Preparer—Authority to practice before the IRS is li\
mited. An unenrolled return preparer may represent, provided the prepare\
r (1)  prepared and signed the return or claim for refund (or prepared if ther\
e is no signature space on the form); (2) was eligible to sign the re\
turn or 
claim for refund; (3) has a valid PTIN; and (4) possesses the requir\
ed Annual Filing Season Program Record of Completion(s).  See Special Rules 
and Requirements for Unenrolled Return Preparers in the instructions for\
 additional information.
k
 Student Attorney or CPA—receives permission to represent taxpayers be\
fore the IRS by virtue of his/her status as a law, business, or accounti\
ng  student working in an LITC or STCP. See instructions for Part II for add\
itional information and requirements.
r
  Enrolled Retirement Plan Agent—enrolled as a retirement plan agent un\
der the requirements of Circular 230 (the authority to practice before \
the 
Internal Revenue Service is limited by section 10.3(e)). 
▶  IF  THIS  DECLARATION  OF REPRESENTATIVE  IS NOT  COMPLETED,  SIGNED, AND DATED,  THE IRS WILL  RETURN  THE 
POWER OF ATTORNEY. REPRESENTATIVES MUST SIGN IN THE ORDER LISTED IN PART\
 I, LINE 2. 	
Note: For designations d-f, enter your title, position, or relationship to the\
 taxpayer in the "Licensing jurisdiction" column. 
Designation—
Insert above  letter (a–r). 	Licensing jurisdiction  (State) or other 
licensing authority  (if applicable).  	Bar, license, certification, 
registration, or enrollment  number (if applicable).    	
Signature 	Date 	
Form 	2848	 (Rev. 12-2015)