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RM 2848(2021 年 1 月修订) 财政部 国税局
rm 2848
(Rev. January 2021)
Department of the Treasury Internal Revenue Service
rm 2848 (Rev. January 2021) Department of the Treasury Internal Revenue Service| rm 2848 | | :--- | | (Rev. January 2021) | | Department of the Treasury Internal Revenue Service |
OMB No. 1545-0150  OMB 编号 1545-0150
For IRS Use Only Received by: Name qquad\qquad
仅供国税局使用 收件人:姓名 qquad\qquad
Part 1 Power of Attorney
第 1 部分 授权书
Telephone  电话
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.
注意:必须为每个纳税人填写单独的 2848 表格。除了在国税局代表之外,2848 表格不会出于任何目的而兑现。
Function  功能
Date  日期
1 Taxpayer information. Taxpayer must sign and date this form on page 2, line 7.
1 纳税人信息。纳税人必须在第 2 页第 7 行签署此表格并注明日期。
Taxpayer name and address
纳税人姓名和地址
Taxpayer identification number(s) 98-1593089
纳税人识别号 98-1593089
2415 W ENGLISH ROAD
英吉利路西 2415 号
CHINASIA TEXTILE (HONG KONG) LIMITED
中国纺织(香港)有限公司
HIGH POINT,  高点, Daytime telephone number 5174740801
日间电话号码5174740801
Plan number (if applicable)
计划编号(如适用)
hereby appoints the following representative(s) as attorney(s)-in-fact:
特此指定以下代表人为代理人:
2 Representative(s) must sign and date this form on page 2, Part II.
2 代表必须在第 2 页第二部分签署并注明日期。
Name and address  姓名和地址
  CAF 编号 5005-96314R
CAF No.
5005-96314R
CAF No. 5005-96314R| CAF No. | | :--- | | 5005-96314R |
REGINA PETRANGELI  雷吉娜·佩特兰杰利
  PTIN P01330458
PTIN
P01330458
PTIN P01330458| PTIN | | :--- | | P01330458 |
P. O. BOX 19608
邮政信箱 19608
Telephone No. 336 232 0572 336 232 0572 quad336-232-0572\quad 336-232-0572  电话号码 336 232 0572 336 232 0572 quad336-232-0572\quad 336-232-0572
GREENSBORO,  格林斯博罗
  传真号码 336-294-4495
Fax No.
336-294-4495
Fax No. 336-294-4495| Fax No. | | :--- | | 336-294-4495 |
Check if to be sent copies of notices and communications
检查是否要发送通知和通信的副本
[X]  [十] Check if new: Address \square Telephone No. \square Fax No.
检查是否为新:地址电话号码 \square \square 传真号码
Name and address  姓名和地址 CAF No. ......0312-26390R
CAF 编号......0312-26390R
BETHANY BANKS  贝瑟尼·班克斯
  PTIN P01279900
PTIN
P01279900
PTIN P01279900| PTIN | | :--- | | P01279900 |
PO BOX 19608  邮政信箱 19608 Telephone No. 336-232-4423
电话 336-232-4423
GREENSBORO,  格林斯博罗 Fax No.  传真号码
Check if to be sent copies of notices and communications
检查是否要发送通知和通信的副本
X Check if new: Address \square
检查是否为新:地址 \square
Name and address  姓名和地址
  CAF 编号 0305-66544R
CAF No.
0305-66544R
CAF No. 0305-66544R| CAF No. | | :--- | | 0305-66544R |
RICKI HALL  瑞奇·霍尔 PTIN
1501 HIGHWOODS BLVD, STE. 300
1501 HIGHWOODS BLVD, 圣。300
Telephone No. 336 232 0576 336 232 0576 quad336-232-0576\quad 336-232-0576  电话号码 336 232 0576 336 232 0576 quad336-232-0576\quad 336-232-0576
GREENSBORO,  格林斯博罗 Fax No.  传真号码
(Note: IRS sends notices and communications to only two representatives.)
(注意:国税局仅向两名代表发送通知和通信。
Check if new: Address \square Telephone No. \square Fax No.
检查是否为新:地址电话号码 \square \square 传真号码
Name and address  姓名和地址 CAF No.  CAF 编号
PTIN

电话号码 传真号码
Telephone No.
Fax No.
Telephone No. Fax No.| Telephone No. | | :--- | | Fax No. |
(Note: IRS sends notices and communications to only two representatives.)
(注意:国税局仅向两名代表发送通知和通信。
Check if new: Address \square Telephone No. \square Fax No. \square
检查是否为新:地址电话号码 \square \square 传真号码 \square
"rm 2848 (Rev. January 2021) Department of the Treasury Internal Revenue Service" OMB No. 1545-0150 For IRS Use Only Received by: Name qquad Part 1 Power of Attorney Telephone 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. Function Date 1 Taxpayer information. Taxpayer must sign and date this form on page 2, line 7. Taxpayer name and address Taxpayer identification number(s) 98-1593089 2415 W ENGLISH ROAD CHINASIA TEXTILE (HONG KONG) LIMITED HIGH POINT, Daytime telephone number 5174740801 Plan number (if applicable) hereby appoints the following representative(s) as attorney(s)-in-fact: 2 Representative(s) must sign and date this form on page 2, Part II. Name and address "CAF No. 5005-96314R" REGINA PETRANGELI "PTIN P01330458" P. O. BOX 19608 Telephone No. quad336-232-0572 GREENSBORO, "Fax No. 336-294-4495" Check if to be sent copies of notices and communications [X] Check if new: Address ◻ Telephone No. ◻ Fax No. Name and address CAF No. ......0312-26390R BETHANY BANKS "PTIN P01279900" PO BOX 19608 Telephone No. 336-232-4423 GREENSBORO, Fax No. Check if to be sent copies of notices and communications X Check if new: Address ◻ Name and address "CAF No. 0305-66544R" RICKI HALL PTIN 1501 HIGHWOODS BLVD, STE. 300 Telephone No. quad336-232-0576 GREENSBORO, Fax No. (Note: IRS sends notices and communications to only two representatives.) Check if new: Address ◻ Telephone No. ◻ Fax No. Name and address CAF No. PTIN "Telephone No. Fax No." (Note: IRS sends notices and communications to only two representatives.) Check if new: Address ◻ Telephone No. ◻ Fax No. ◻ | rm 2848 <br> (Rev. January 2021) <br> Department of the Treasury Internal Revenue Service | | | | | OMB No. 1545-0150 | | :--- | :--- | :--- | :--- | :--- | :--- | | | | | | | For IRS Use Only Received by: Name $\qquad$ | | | | | | | | | Part 1 Power of Attorney | | | | | Telephone | | 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. | | | | | Function | | | | | | | Date | | 1 Taxpayer information. Taxpayer must sign and date this form on page 2, line 7. | | | | | | | | Taxpayer name and address | | Taxpayer identification number(s) 98-1593089 | | | | 2415 W ENGLISH ROAD | CHINASIA TEXTILE (HONG KONG) LIMITED | | | | | | | HIGH POINT, | | Daytime telephone number 5174740801 | | Plan number (if applicable) | | hereby appoints the following representative(s) as attorney(s)-in-fact: | | | | | | | 2 Representative(s) must sign and date this form on page 2, Part II. | | | | | | | Name and address | | | CAF No. <br> 5005-96314R | | | | | REGINA PETRANGELI | | PTIN <br> P01330458 | | | | | P. O. BOX 19608 | | Telephone No. $\quad 336-232-0572$ | | | | | GREENSBORO, | | Fax No. <br> 336-294-4495 | | | | | Check if to be sent copies of notices and communications | [X] | Check if new: Address $\square$ Telephone No. $\square$ Fax No. | | | | Name and address | | | CAF No. ......0312-26390R | | | | | BETHANY BANKS | | PTIN <br> P01279900 | | | | | PO BOX 19608 | | Telephone No. 336-232-4423 | | | | | GREENSBORO, | | Fax No. | | | | | Check if to be sent copies of notices and communications | X | Check if new: Address $\square$ | | | | Name and address | | | CAF No. <br> 0305-66544R | | | | RICKI HALL | | | PTIN | | | | | 1501 HIGHWOODS BLVD, STE. 300 | | Telephone No. $\quad 336-232-0576$ | | | | | GREENSBORO, | | Fax No. | | | | | (Note: IRS sends notices and communications to only two representatives.) | | Check if new: Address $\square$ Telephone No. $\square$ Fax No. | | | | Name and address | | | CAF No. | | | | | | | PTIN | | | | | | | Telephone No. <br> Fax No. | | | | | (Note: IRS sends notices and communications to only two representatives.) | | Check if new: Address $\square$ Telephone No. $\square$ Fax No. $\square$ | | |
to represent the taxpayer before the Internal Revenue Service and perform the following acts:
在国税局代表纳税人并执行以下行为:

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 5 a for authorizing a representative to sign a return).
3 授权行为(您需要填写第 3 行)。除第 5b 行所述的行为外,我授权我的代表接收和检查我的机密税务信息,并就下述税务事项执行我可以执行的行为。例如,我的代表应有权签署任何协议、同意书或类似文件(请参阅授权代表签署申报表的第 5 a 行的说明)。
Description of Matter (Income, Employment, Payroll, Excise, Estate, Gift, Whistleblower, Practitioner Discipline, PLR, FOIA, Civil Penalty, Sec. 4980 H Shared Responsibility Payment, etc.) (see instructions)
事项描述(收入、就业、工资、消费税、遗产、礼物、举报人、从业者纪律、PLR、FOIA、民事处罚、第 4980 H 条分担责任付款等)(见说明)
Tax Form Number (1040, 941, 720, etc.) (if applicabie)
税表编号(1040、941、720 等)(如果适用)
Year(s) of Period(s) (if applicable) (see instructions)
期间年份(如适用)(见说明)
INCOME TAX  所得税 1120F 2021-2025
Description of Matter (Income, Employment, Payroll, Excise, Estate, Gift, Whistleblower, Practitioner Discipline, PLR, FOIA, Civil Penalty, Sec. 4980 H Shared Responsibility Payment, etc.) (see instructions) Tax Form Number (1040, 941, 720, etc.) (if applicabie) Year(s) of Period(s) (if applicable) (see instructions) INCOME TAX 1120F 2021-2025 | Description of Matter (Income, Employment, Payroll, Excise, Estate, Gift, Whistleblower, Practitioner Discipline, PLR, FOIA, Civil Penalty, Sec. 4980 H Shared Responsibility Payment, etc.) (see instructions) | Tax Form Number (1040, 941, 720, etc.) (if applicabie) | Year(s) of Period(s) (if applicable) (see instructions) | | :--- | :--- | :--- | | INCOME TAX | 1120F | 2021-2025 | | | | | | | | |
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. See Line 4. Specific Use Not Recorded on CAF in the instructions
4 集中授权文件 (CAF) 中未记录的特定用途。如果授权书用于未记录在 CAF 上的特定用途,请选中此框。见第 4 行。说明书中未记录在 CAF 上的具体用途

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 5 a for more information): \square Access my IRS records via an Intermediate Service Provider;
5a 授权的附加行为。除了上述第 3 行列出的行为外,我还授权我的代表执行以下行为(有关更多信息,请参阅第 5 a 行的说明): \square 通过中间服务提供商访问我的 IRS 记录;

Authorize disclosure to third parties; Substitute or add representative(s); Sign a return;
授权向第三方披露;替换或增加代表;签署退货;

Other acts authorized: qquad\qquad
其他授权行为: qquad\qquad

b 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): qquad\qquad
b 未经授权的具体行为。我的代表无权背书或以其他方式协商政府签发的任何支票(包括通过任何电子或其他方式直接或接受付款到代表或与代表有关联的任何公司或其他实体拥有或控制的账户)由政府签发的联邦纳税义务。列出本授权书中其他授权的行为的任何其他具体删除(参见第 5b 行的说明): qquad\qquad
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. If you do not want to revoke a prior power of attorney, check here qquad\qquad > > >> YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT.
6 保留/撤销先前的授权书。提交此授权书将自动撤销所有先前向美国国税局存档的授权书,涉及本表格涵盖的相同事项和年份或期限。如果您不想撤销先前的授权书,请在此处 qquad\qquad > > >> 查看您必须附上您希望保持有效的任何授权书的副本。

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.
7 纳税人申报和签字。如果税务事项涉及提交联合申报表的年份,即使配偶双方指定了相同的代表,也必须提交单独的授权书。如果由公司高管、合伙人、监护人、税务事务合伙人、合伙代表(或指定个人,如适用)、遗嘱执行人、接管人、管理人、受托人或纳税人以外的个人签署,我证明我有合法权力代表纳税人签署此表格。
  • IF NOT COMPLETED, SIGNED, AND DATED, THE IRS WILL RETURN THIS POWER OF ATTORNEY TO THE TAXPAYER.
    如果未填写、签名和注明日期,国税局会将此授权书退还给纳税人。
  签名日期
Signature
Date
Signature Date| Signature | | :--- | | Date |
Part II. Declaration of Representative
第二部分。代表声明

根据伪证罪的处罚,我在下面签名声明:- 我没有被美国国税局停职或取消执业资格,或没有资格执业; - 我受经修订的第 230 号通知(31 CFR,副标题 A,第 10 部分)中管理美国国税局实践的规定的约束; - 我有权代表第一部分中确定的纳税人处理其中指定的事项;以及 - 我是以下之一: 律师 - 信誉良好的下述司法管辖区最高法院律师协会成员。 b 注册会计师 - 持有在下列司法管辖区担任注册会计师的有效执照。 c 注册代理人 - 根据 Gircular 230 的要求,由 IRS 注册为代理人。 d 官员 - 纳税人组织的真正官员。 e 全职雇员 - 纳税人的全职雇员。 f 家庭成员 - 纳税人的直系亲属(配偶、父母、子女、祖父母、孙子女、继父母、继子女、兄弟或姐妹)的成员。 9 注册精算师 - 根据 29 U.S.C. 1242 被精算师注册联合委员会注册为精算师(在 IRS 执业的权力受第 230 号通知第 10.3(d) 条的限制)。h 未注册的报税员 - 在国税局之前执业的权力是有限的。未经修改的代报税人可以代表,前提是代报税人 (1) 准备并签署退税申报表或退款申请(如果表格上没有签名空格,则准备);(2) 有资格签署退货或申请退款;(3) 拥有有效的 PTIN;(4) 拥有所需的年度报税季计划完成记录。 有关更多信息,请参阅说明中针对未注册报税员的特殊规则和要求。k 合格学生或法律毕业生 - 凭借他/她作为法律、商业或会计学生的身份,或在 LITC 或 STCP 工作的法律毕业生,获得在 IRS 代表纳税人的许可。有关更多信息和要求,请参阅第 II 部分的说明。 r 注册退休计划代理人 - 根据第 230 号通知的要求注册为退休计划代理人(在国税局执业的权力受第 10.3(e) 条的限制)。 如果此代表声明未填写、签名并注明日期,国税局将退回授权书。 代表必须按照第 2 行中列出的顺序签名。  如果此代表声明未填写、签名并注明日期,国税局将退回授权书。   代表必须按照第 2 行中列出的顺序签名。  {:[“ 如果此代表声明未填写、签名并注明日期,国税局将退还授权书。按照第 2 行第 2 行中列出的顺序。“]:}\begin{aligned} & \text { 如果此代表声明未填写、签名并注明日期,国税局将退回授权书。\\ & \text { 代表必须按照第 2 行第 2 行中列出的顺序签名。 } \end{对齐} 注意: 对于名称 d-f,请在“许可管辖区”列中输入您的头衔、职位或与纳税人的关系。
Under penalties of perjury, by my signature below I declare that:
- I am not carrently suspended or disbarred from practice, or ineligible for practice, before the Internal Revenue Service;
- 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 Gircular 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).
9 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 unemolled 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(s). 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. REPRESENIATIVES MUST SIGN IN THE ORDER LISTED IN PARTI, LINE 2.  IF THIS DECLARATION OF REPRESENTATIVE IS NOT COMPLETED, SIGNED, AND DATED, THE IRS WILL RETURN THE POWER OF ATTORNEY.   REPRESENIATIVES MUST SIGN IN THE ORDER LISTED IN PARTI, LINE 2.  {:[" IF THIS DECLARATION OF REPRESENTATIVE IS NOT COMPLETED, SIGNED, AND DATED, THE IRS WILL RETURN THE POWER OF ATTORNEY. "],[" REPRESENIATIVES MUST SIGN IN THE ORDER LISTED IN PARTI, LINE 2. "]:}\begin{aligned} & \text { IF THIS DECLARATION OF REPRESENTATIVE IS NOT COMPLETED, SIGNED, AND DATED, THE IRS WILL RETURN THE POWER OF ATTORNEY. } \\ & \text { REPRESENIATIVES MUST SIGN IN THE ORDER LISTED IN PARTI, LINE 2. } \end{aligned}
Note: For designations d-f, enter your title, position, or relationship to the taxpayer in the "Licensing jurisdiction" column.
Under penalties of perjury, by my signature below I declare that: - I am not carrently suspended or disbarred from practice, or ineligible for practice, before the Internal Revenue Service; - 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 Gircular 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). 9 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 unemolled 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(s). 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., REPRESENIATIVES MUST SIGN IN THE ORDER LISTED IN PARTI, LINE 2. Note: For designations d-f, enter your title, position, or relationship to the taxpayer in the "Licensing jurisdiction" column.| Under penalties of perjury, by my signature below I declare that: | | :--- | | - I am not carrently suspended or disbarred from practice, or ineligible for practice, before the Internal Revenue Service; | | - 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 Gircular 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). | | 9 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 unemolled 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(s). 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)). $\begin{aligned} & \text { IF THIS DECLARATION OF REPRESENTATIVE IS NOT COMPLETED, SIGNED, AND DATED, THE IRS WILL RETURN THE POWER OF ATTORNEY. } \\ & \text { REPRESENIATIVES MUST SIGN IN THE ORDER LISTED IN PARTI, LINE 2. } \end{aligned}$ | | Note: For designations d-f, enter your title, position, or relationship to the taxpayer in the "Licensing jurisdiction" column. |
Designation Insert above letter ( a r a r a-r\mathrm{a}-\mathrm{r} ).
名称 插入字母 ( ) 上方 a r a r a-r\mathrm{a}-\mathrm{r}
Licensing jurisdiction (State) or other licensing authority (if applicable)
许可管辖区(州)或其他许可机构(如适用)
Bar, license, certification, registration, or enrollment number (if applicable)
酒吧、执照、认证、注册或注册号(如果适用)
Signature  签名 Date  日期
B NC 29025
07/31/25
B VA 44095 07/31/25
B NC 35034 07/31/25
"Signature Date" Part II. Declaration of Representative "Under penalties of perjury, by my signature below I declare that: - I am not carrently suspended or disbarred from practice, or ineligible for practice, before the Internal Revenue Service; - 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 Gircular 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). 9 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 unemolled 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(s). 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., REPRESENIATIVES MUST SIGN IN THE ORDER LISTED IN PARTI, LINE 2. Note: For designations d-f, enter your title, position, or relationship to the taxpayer in the "Licensing jurisdiction" column." Designation Insert above letter ( a-r ). Licensing jurisdiction (State) or other licensing authority (if applicable) Bar, license, certification, registration, or enrollment number (if applicable) Signature Date B NC 29025 https://cdn.mathpix.com/cropped/2025_08_06_9e7e10d65f356fbaa7bag-2.jpg?height=190&width=552&top_left_y=2005&top_left_x=925 07/31/25 B VA 44095 07/31/25 B NC 35034 07/31/25 | Signature <br> Date | | | | | | | :--- | :--- | :--- | :--- | :--- | :--- | | | | | | | | | Part II. Declaration of Representative | | | | | | | Under penalties of perjury, by my signature below I declare that: <br> - I am not carrently suspended or disbarred from practice, or ineligible for practice, before the Internal Revenue Service; <br> - I am subject to regulations in Circular 230 (31 CFR, Subtitle A, Part 10), as amended, governing practice before the Internal Revenue Service; <br> - I am authorized to represent the taxpayer identified in Part I for the matter(s) specified there; and <br> - I am one of the following: <br> a Attorney - a member in good standing of the bar of the highest court of the jurisdiction shown below. <br> b Certified Public Accountant - a holder of an active license to practice as a certified public accountant in the jurisdiction shown below. <br> c Enrolled Agent - enrolled as an agent by the IRS per the requirements of Gircular 230. <br> d Officer - a bona fide officer of the taxpayer organization. <br> e Full-Time Employee - a full-time employee of the taxpayer. <br> f Family Member - a member of the taxpayer's immediate family (spouse, parent, child, grandparent, grandchild, step-parent, step-child, brother, or sister). <br> 9 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). <br> h Unenrolled Return Preparer - Authority to practice before the IRS is limited. An unemolled 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(s). See Special Rules and Requirements for Unenrolled Return Preparers in the instructions for additional information. <br> 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. <br> 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)). $\begin{aligned} & \text { IF THIS DECLARATION OF REPRESENTATIVE IS NOT COMPLETED, SIGNED, AND DATED, THE IRS WILL RETURN THE POWER OF ATTORNEY. } \\ & \text { REPRESENIATIVES MUST SIGN IN THE ORDER LISTED IN PARTI, LINE 2. } \end{aligned}$ <br> Note: For designations d-f, enter your title, position, or relationship to the taxpayer in the "Licensing jurisdiction" column. | | | | | | | Designation Insert above letter ( $\mathrm{a}-\mathrm{r}$ ). | Licensing jurisdiction (State) or other licensing authority (if applicable) | Bar, license, certification, registration, or enrollment number (if applicable) | Signature | | Date | | B | NC | 29025 | ![](https://cdn.mathpix.com/cropped/2025_08_06_9e7e10d65f356fbaa7bag-2.jpg?height=190&width=552&top_left_y=2005&top_left_x=925) | | 07/31/25 | | B | VA | 44095 | | | 07/31/25 | | B | NC | 35034 | | | 07/31/25 | | | | | | | |