Fillable Printable Sample Power of Attorney Form - Iowa

Sample Power of Attorney Form - Iowa

Iowa Department of Revenue

www.iowa.gov/tax IA 2848 Iowa Power of Attorney Form

14-101a (09/11/14)

Please type or print.

Note: Read Instructions before completing form. Failure to provide all required information will result in this

form not being valid and will delay the effective date of the power of attorney (POA).

1. Taxpayer Information. Note: Taxpayer(s) must sign and date this form on page 2, section 8.

Taxpayer name and address

Note: If this POA is for a business, provide legal and trade names.

Social Security Number (SSN)

Federal Employer Identification Number (FEIN)

Tax permit number

Phone

Spouse name and address

Note: Spouse is only applicable if you filed joint returns.

SSN

Phone

2. Representative(s).

Note: You must include SSN, FEIN, or Preparer’s Tax ID Number (PTIN). Attach a schedule for additional

representatives.

Individual’s name

SSN, FEIN, or PTIN of the representative (Required)

Firm or company’s legal name for individual listed on previous line

Phone

Mailing address

Fax number

Em ail

Individual’s name

SSN, FEIN, or PTIN of the representative (Required)

Firm or company’s legal name for individual listed on previous line

Phone

Mailing address

Fax number

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):

3. Tax Matters.

Note: Tax type, permit and tax periods must be provided.

Tax Periods (beginning and ending tax periods required)

List Type of Tax

(See instructions for options)

Iowa Tax Permit Number

Beginning Tax Period(MM/YY)

(Unlimited prior periods)

Ending Tax Period (MM/YY)

(Limited to 3 years from

date form is received)

IA 2848 Iowa Power of Attorney Form, page 2

14-101b (09/11/14)

4. Acts Authorized.

Representatives are authorized to receive and inspect confidential ta x information and to perform any and all

acts with respect to the tax matters described in section 3. For example, the representative may negotiate, sign

any agreements, consents, or other documents, and represent the taxpayer(s) in any informal and formal

proceeding involving the Department. The authority does not include the power to receive refund checks (see

section 5 below) or the power to substitute another representative, unless specifically added below. List any

specific additions or deletions to the acts otherwise authorized in this power of attorney:

Additions:

Deletions: __________________________________________________________________________________________

5. Receipt of Refund Checks.

If you want to authorize a representative named in section 2 to receive, BUT NOT TO ENDORSE OR CASH,

refund checks, initial here ______ and list the name of that representative below.

Name of representative to receive refund check(s): ______________________________________________________

Note: By initialing, this does not authorize the representative to endorse or cash refund checks.

6. Notices and Communications.

Original notices and other written communications will be sent to you and the taxpayer. A copy will be sent to the

first representative listed in section 2.

7. 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 Iowa

Department of Revenue for the same tax matters and tax periods covered by this document.

If you do not want to revoke a prior power of attorney, check here:

Note: YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT.

8. Signature of Taxpayer(s).

If a tax matter concerns a joint individual income tax return, both spouses are required to sign this form, if

represented by the same individual(s).

If signed by a corporate officer, partner, member, 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.

Note: If the taxpayer is an entity with more than one owner or member, a second signature of a person

authorized to legally bind the entity is required.

If this form is not signed and dated, this Power of Attorney will not be valid. The form will be returned to you.

Signature

Date

Print Name

Title

Signature

Date

Print Name

Title

Mail to:

Registration Services

Iowa Department of Revenue

PO Box 10470

Des Moines IA 50306-0470

Or fax to: 515-281-3906

Instructions, IA 2848 Iowa Power of Attorney

14-101c (09/11/14)

Purpose of form

Taxpayer information is confidential. The Iowa Department of

Revenue will discuss confidential tax information only with the

taxpayer, unless the taxpayer has a valid power of attorney

form on file with the Department.

A power of attorney is required by the Department when the

taxpayer wishes to authorize another person to perform one

or more of the following on behalf of the taxpayer:

a. To receive copies of notices or documents sent by the

Department, its representatives, or its attorneys.

b. To receive (but not to endorse and collect) checks in

payment of any refund of Iowa taxes, penalties, or

interest.

c. To request waivers (including offers of waivers) of

restrictions on assessment or collection of tax

deficiencies and waivers of notice of disallowance of a

claim for credit or refund.

d. To request extensions of time for assessment or

collection of taxes.

e. To fully represent the taxpayer(s) in any formal or

informal meeting with the Department, hearing,

determination, final or otherwise, or appeal.

f. To enter into any compromise with the Department.

g. To execute any release from liability required by the

Department before divulging otherwise confidential

information concerning taxpayer(s).

h. Other acts as expressly stipulated in writing by the

taxpayer.

3. Tax Matters

Tax type options

Enter tax type in section 3 and include beginning and

ending dates for each.

Individual Income

Partnership

Sales and Use

Inheritance

Corporation

Franchise

Withholding

Fiduciary

Other (specify)

Tax periods

Specific tax periods must be identified. Each tax period

must be separately stated. An unlimited number of prior

tax periods may be listed on the form.

Beginning Tax Period

Enter the date using MM/YY format. MM represents the

two-digit month; YY is the last two digits of the year.

Ending tax period

Statute of limitations - A power of attorney may be effective

for no more than three years from the date it is received by

the Department.

7. Retention / Revocation of prior Power(s) of Attorney

Canceling a power of attorney

A power of attorney may be revoked by a taxpayer at any

time by filing a statement of revocation with the

Department. The statement must indicate that the authority

of the previous power of attorney is revoked and must be

signed and dated by the taxpayer. Also, the name and

address of each representative whose authority is revoked

must be listed or a copy of the power of attorney must be

attached. Revocation of the authority to represent the

taxpayer before the Department will be effective on the

date received by the Department.

Submitting a new power of attorney

A new power of attorney for a particular tax type(s) and tax

period(s) revokes a prior power of attorney for those tax

type(s) and tax period(s), unless the taxpayer indicates on

the new power of attorney form that a prior power of

attorney is to remain in effect. The effective date of a new

power of attorney is the date it is received by the

Department.

For a previously-designated representative to remain as

the taxpayer’s representative when a new power of

attorney form is filed, a taxpayer must attach a copy of the

prior power of attorney form that designates the

representative that the taxpayer wishes to retain.

Withdrawing as a representative

A representative may withdraw from representing a

taxpayer by filing a statement with the Department. The

statement must be signed and dated by the representative

and must identify the name and address of the taxpayer(s)

and the matter(s) from which the representative is

withdrawing.

8. Signature of Taxpayer(s)

Who must sign?

Individual taxpayer. A power of attorney form must be

signed by the individual.

Joint returns. If a tax matter concerns a joint individual

income tax return, both taxpayers must sign and date.

Corporation. An officer of the corporation having authority

to legally bind the corporation must sign the power of

attorney form. The corporation must certify that the officer

has such authority.

Association. An officer of the association having authority

to legally bind the association must sign the power of

attorney form. The association must certify that the officer

has such authority.

Partnership. A power of attorney must be signed by all

partners, or if executed in the name of the partnership, by

the partner or partners duly authorized to act for the

partnership, who must certify that the partner(s) has such

authority.

Federal Power of Attorney

The Federal Power of Attorney form or a Military Power of

Attorney is accepted by the Iowa Department of Revenue. To

be valid, the federal or military form must include a statement

that it is applicable for Iowa purposes at the time it is

executed. In the case of a previously executed Federal or

Military Power of Attorney subsequently revised to apply for

Iowa purposes, it must contain a written statement that

indicates it is being submitted for use with State of Iowa forms

and the statement needs to be initialed by the taxpayer. Iowa

allows married taxpayers to file one Iowa Power of Attorney

form on behalf of both spouses. The IRS requires separate

Power of Attorney forms for each spouse. If the Federal

Power of Attorney is being used for Iowa purposes by married

taxpayers, both federal forms must be submitted to Iowa.

Mail this form to:

Registration Services

Iowa Department of Revenue

PO Box 10470

Des Moines IA 50306-0470

or fax this form to 515-281-3906.