District of Columbia Tax Power of Attorney Form 1 - Free Download | Page 2
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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 and 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
Declaration of Representative Representative(s) must complete this section and sign below.
Under penalties of perjury, I declare that:
• I am not currently under suspension or disbarment from practice before the Internal Revenue Service;
• I am aware of regulations, contained in Treasury Department Circular # 230, as amended, concerning the
practice of attorneys, certified public accountants, enrolled agents, enrolled actuaries, and others; and the
penalties for false or fraudulent statements provided in DC Official Code Section 47-4106;
• I am authorized to represent in the District of Columbia, the taxpayer(s) identified for the tax matter(s) specified
herein; and 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 An actuary enrolled by the Joint Board for the Enrollment of Actuaries under 29 U.S.C. (the authority to
practice before IRS is limited by section 10.3(d)(1) of Treasury Department Circular # 230).
h An unenrolled return preparer under section 10.7(c)(viii) of Treasury Department Circular # 230.
i A general partner of a partnership.
j Other
Designation-Inset above Jurisdiction (state) Signature Date
letter (a-j)
If this declaration is not signed and dated, this power of attorney will be returned
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If not signed and dated, this power of attorney will be returned