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Government of the District of ColumbiaD-2848 Power of Attorney andDeclaration of RepresentationPersonal InformationYour first name, , Last name for individual or Business name for businessSpouse first name, , Last name for individualYour SSN or EIN for businessSpouse s SSNYour daytime phone numberHome address (number and street) or business addressApartment numberCityStateZip codehereby appoint(s) the following representative(s) as attorney(s)-in-fact:Representative(s) This Power of Attorney will not be valid unless the Representative(s) complete the Declaration of Representative, sign and date this form on page and addressName and addressEIN/SSNPTINT elephone Number Fax AddressName and addressEIN/SSNPTINT elephone NumberFax AddressName and addressEIN/SSNPTINT elephone NumberFax AddressTax MattersType of Tax ( income , Sales, etc)Type FormYears or PeriodsActs authorizedThe representatives are authorized to represent the taxpayer (s) before the Office of Tax and Revenue for the tax matters listed above, to receive and inspect confidential tax information and to perform any and all acts that I (we) can perform (for exampl)

a law, business, or accounting student working in an Low Income Taxpayer Clinic or Student Tax Clinic Program. D-2848 Page 2 Designation-Insert above letter (a-i) Signature Date If this declaration is not signed and dated, this power of attorney will be returned Licensing jurisdiction (state) or other licensing authority (if applicable)

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  Income, Clinic, Taxpayer, Low income taxpayer clinics

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