Form 2848

Form 2848 (Rev. January 2021)
Power of Attorney and Declaration of Representative
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.
Taxpayer information. Taxpayer must sign and date this form.
Taxpayer name *
Taxpayer Complete address*
Taxpayer identification number(s)*
Daytime Telephone Number*
Representative(s) must sign
Representative 1: Name and address
KELLI LEWIS KELLIWORKS ACCOUNTING FIRM LLC 2000 MORRIS AVE STE 1 UNION, NJ 07083-3517-015
Check if to be sent copies of notices and communications
PTIN
CAF
Telephone No.
Fax No.
3. Acts authorized (you are required to complete line 3 )

Except for the acts described in line 5b, I authorize my representative(s) to receive and inspect my confidential tax information and to perform acts I can perform with respect to the tax matters described below. For example, my representative(s) shall have the authority to sign any agreements, consents, or similar documents (see instructions for line 5a for authorizing a representative to sign a return

	Description of Matter (Income, Employment, Payroll, Excise, Estate, Gift, Whistleblower, Practitioner Discipline, PLR, FOIA, Civil Penalty, Sec. 4980H Shared Responsibility Payment, etc.) (see instructions)	Tax Form Number (1040, 941, 720, etc.) (if applicable)	Year(s) or Period(s) (if applicable) (see instructions)
1

Acts Authorized
All Matters - Income and Employment
Tax Form*
Year's Needed
4. Specific use not recorded on the Centralized Authorization File (CAF)
If the power of attorney is for a specific use not recorded on CAF, check this box

.
5A. Additional acts authorized.

In addition to the acts listed on line 3 above, I authorize my representative(s) to perform the following acts (see instructions for line 5a for more information):
Access my IRS records via an Intermediate Service Provider;Authorize disclosure to third parties;Substitute or add representative(s);Sign a returnOther acts authorized
5B. 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 this 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 form. YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT.
7 Taxpayer declaration and signature.

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, partnership representative (or designated individual, if applicable), executor, receiver, administrator, trustee, or individual other than the taxpayer, I certify I have the legal authority to execute this form on behalf of the taxpayer.
IF NOT COMPLETED, SIGNED, AND DATED, THE IRS WILL RETURN THIS POWER OF ATTORNEY TO THE TAXPAYER.*

MonthDayYear
Date
Signature*

Clear
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 subject to regulations in Circular 230 (31 CFR, Subtitle A, Part 10), as amended, governing practice before the Internal Revenue 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—a holder of an active license to practice as a certified public accountant in the jurisdiction shown below.

c Enrolled Agent—enrolled as an agent by the IRS per 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, brother, or sister

g Enrolled Actuary—enrolled as an actuary by the Joint Board for the Enrollment of Actuaries under 29 U.S.C. 1242 (the authority to practice before the IRS is limited by section 10.3(d) of Circular 230

h Unenrolled Return Preparer—Authority to practice before the IRS is limited. An unenrolled return preparer may represent, provided the preparer (1) prepared and signed the return or claim for refund (or prepared if there is no signature space on the form); (2) was eligible to sign the return or claim for refund; (3) has a valid PTIN; and (4) possesses the required Annual Filing Season Program Record of Completion . See Special Rules and Requirements for Unenrolled Return Preparers in the instructions for additional information.

k Qualifying Student or Law Graduate—receives permission to represent taxpayers before the IRS by virtue of his/her status as a law, business, or accounting student, or law graduate working in a LITC or STCP. See instructions for Part II for additional information and requirements.

r Enrolled Retirement Plan Agent—enrolled as a retirement plan agent under 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.
Designation—Insert above letter (a–r).
Representative
Date*

MonthDayYear
Date
Should be Empty:

Power of Attorney and Declaration of Representative

Part I

Representative(s) must sign

3. Acts authorized (you are required to complete line 3 )

4. Specific use not recorded on the Centralized Authorization File (CAF)

5A. Additional acts authorized.

5B. Specific acts not authorized.

6. Retention/revocation of prior power(s) of attorney.

7 Taxpayer declaration and signature.

PART II: Declaration of Representative