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Illinois Department of Revenue
*65304201W*
Form IL-2848-A
Power of Attorney Additional Information Attachment # _____
Form IL-2848, Step 5, signature date _____ / _____ / _____
mm dd yyyy
Taxpayer’s Name (person or business) FEIN, SSN, or Illinois Account ID
Power of Attorney Information
(Complete Step 6
Check one box: Attorney Certified Public Accountant Enrolled Agent Other of Form IL-2848)
Power of Attorney’s name Firm Name
Identification Number (Attorney License, PTIN, FEIN, SSN) Email Address
Power of Attorney’s Street Address City State ZIP
( ) ( )
Daytime Phone Number Fax Number
If your Power of Attorney is an attorney, certified public accountant, or enrolled agent, the Power of Attorney must complete this section:
I declare that I am not currently under suspension or disbarment, and that I am
• a member in good standing of the highest court of the jurisdiction indicated;
or
• duly qualified to practice as a certified public accountant in the
jurisdiction indicated; Power of Attorney Signature Date
or
• enrolled as an agent pursuant to the requirements of United
States Treasury Circular #230.
Power of Attorney Printed Name Jurisdiction
Power of Attorney Information
(Complete Step 6
Check one box: Attorney Certified Public Accountant Enrolled Agent Other of Form IL-2848)
Power of Attorney’s name Firm Name
Identification Number (Attorney License, PTIN, FEIN, SSN) Email Address
Power of Attorney’s Street Address City State ZIP
( ) ( )
Daytime Phone Number Fax Number
If your Power of Attorney is an attorney, certified public accountant, or enrolled agent, the Power of Attorney must complete this section:
I declare that I am not currently under suspension or disbarment, and that I am
• a member in good standing of the highest court of the jurisdiction indicated;
or
• duly qualified to practice as a certified public accountant in the
jurisdiction indicated;
or Power of Attorney Signature Date
• enrolled as an agent pursuant to the requirements of United
States Treasury Circular #230.
Power of Attorney Printed Name Jurisdiction
This form is authorized by various acts found in Illinois Compiled Statutes. Disclosure of
IL-2848-A (N-08/20) Front this information is REQUIRED. Failure to provide information could result in a penalty.
