Form 2848 (Revised 3-2004) Page 2. Summary: This is an example of Form 2848 (Revised March 2004), page 2, filed to provide power of attorney information to the
Airs regarding a
third party involved with a taxpayer's matters with items included as described in the text. Additionally, these line items
are completed:
| Under
“Part II: Declaration of Representative”:
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“Designation--Insert above letter (a-h)” field contains c (I am one of the following: Enrolled Agent--enrolled as an agent under the
requirements of Treasury Department Circular Number 230.)
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“Jurisdiction (state) or Enrollment Card Number” field contains 90-99999
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“Signature” field contains Jim Smith
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“Date” field contains 2/21/04
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