2848A | Alabama Department of Revenue

   





NAME AND ADDRESS



TAXPAYER NAME AND ADDRESS (Please Type or Print) SOCIAL SECURITY NUMBER

EMPLOYER IDENTIFICATION NUMBER

DAYTIME TELEPHONE NUMBER

( )



FORM

2848A

(REV. 9/18)

NOTE: If you have questions concerning the completion of this form, please refer to the instructions for Federal

Form 2848 (revised March 2012). Alabama Form 2848A is very similar to the federal form.

CAUTION: A separate Form 2848A should be completed for each taxpayer.

PART I – POWER OF ATTORNEY

1 TAXPAYER INFORMATION

2 REPRESENTATIVE(S) (Please Type or Print) Must sign and date this form on page 2, part II. 







3 TAX MATTERS

4 ACTS AUTHORIZED







        



        













 

EXCEPTIONS

 



TELEPHONE NUMBER ( )

FAX NUMBER ( )

TELEPHONE NUMBER ( )

FAX NUMBER ( )

TELEPHONE NUMBER ( )

FAX NUMBER ( )

TYPE OF TAX (Individual, Corporate, Sales, etc.) TAX FORM NUMBER (40, 20C, 41, 65, etc.) YEAR(S) or PERIOD(S)

Clear Form

DESIGNATION – INSERT

ABOVE LETTER (a-k)

JURISDICTION (State) or

ENROLLMENT CARD NO.

SIGNATURE DATE

FORM 2848A (REV. 9/18) PAGE 2

5 RETENTION / REVOCATION OF PRIOR POWER(S) OF ATTORNEY



same  







              

6 SIGNATURE OF TAXPAYER









 

SIGNATURE DATE TITLE (If Applicable)

PRINT NAME

PART II – DECLARATION OF REPRESENTATIVE













 



 



 











 







 





 



 

