Iowa Power of Attorney Form IA 2848
NOTE: A power of attorney may be effective for no more than three years from the date
it is received by the Department. Failure to complete all requested information will result
in this form not being valid and will delay the effective date of the power of attorney.
www.state.ia.us/tax
Iowa Department of Revenue
2. REPRESENTATIVE(S). You must include Preparer’s Tax ID Number (PTIN), Federal Employer ID Number (FEIN),
OR Social Security Number (SSN).
Name PTIN, FEIN, OR SSN (MUST BE INCLUDED)
Firm or Company’s Legal Name Telephone Number
check if new telephone number
Address
check if new address Fax Number
City, State, Zip E-Mail Address
Name PTIN, FEIN, OR SSN (MUST BE INCLUDED)
Firm or Company’s Legal Name Telephone Number
check if new telephone number
Address
check if new address Fax Number
City, State, Zip E-Mail Address
Name PTIN, FEIN, OR SSN (MUST BE INCLUDED)
Firm or Company’s Legal Name Telephone Number
check if new telephone number
Address
check if new address Fax Number
City, State, Zip E-Mail Address
3. TAX MATTERS.
List Type of Tax (see below for options) and the specific tax matter(s). Beginning MM/YY Ending MM/YY
Please type or print
Last name or company legal name Your first name/middle initial Social Security Number •
Spouse’s last name Spouse’s first name/middle initial Social Security Number •
Current mailing address (number and street, apartment, lot or suite number) or PO Box
City, State, Zip
check if new address
Federal Employer Identification Number
State Tax Permit Number
Daytime Telephone Number
check if new telephone number
1. TAXPAYER INFORMATION. Taxpayer(s) must sign and date this form on page 2, section 8.
Attach a schedule for additional representatives.
The above representatives are hereby appointed as attorney(s)-in-fact to represent the taxpayer(s) before the Iowa
Department of Revenue for the following tax matter(s).
Tax type and tax periods must be specifically identified. For inheritance, estate, or generation skipping tax, enter the
decedent’s date of death.
TAX TYPE OPTIONS. Enter tax type in section 3 above and include beginning and ending dates for each.
Individual Income Partnership Sales and Use Inheritance Motor Fuel
Corporation Income Franchise Withholding Fiduciary Environmental Protection Charge
Other (specify) _____________________________
TAX PERIODS
14-101a (09/15/09)
Resume Templates 1210 Document(s)
