US Dept of Treasury IRS 10/14/2020 (2)

Form 2848 Power of Attorney OMB No.1545-0150 (Rev.February 2020) and Declaration of Representative For IRS Use Only Department of the Treasury Received by: Internal Revenue Service ►Go to www.irs.gov/Form2848 for instructions and the latest information. Name Part I Power of Attorney Telephone Caution:A separate Form 2848 must be completed for each taxpayer. Form 2848 will not be honored Function for any purpose other than representation before the IRS. Date / / 1 Taxpayer information.Taxpayer must sign and date this form on page 2,line 7. Taxpayer name and address Taxpayer identification number(s) City of Everett VEBA Trust 83-6346037 2930 Wetmore Avenue,Ste.5-A Daytime telephone number Plan number(if applicable) Everett,WA 98201 425-257-8700 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. 4005-40089R Darcy L.Hitesman PTIN 11238 86th Avenue N Telephone No. 763-503-6620 Maple Grove,MN 55369 Fax No. 763-503-6619 Check if to be sent copies of notices and communications ❑✓ Check if new: Address❑ Telephone No. ❑ Fax No. ❑ Name and address CAF No. PTIN Telephone No. Fax No. Check if to be sent copies of notices and communications ❑ 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. ❑ 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. ❑ to represent the taxpayer before the Internal Revenue Service and perform the following acts: 3 Acts authorized(you are required to complete this line 3).With the exception of the acts described in line 5b,I authorize my representative(s) to receive and inspect my confidential tax information and to perform acts that 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, Tax Form Number Year(s)or Period(s)(if applicable) Whistleblower,Practitioner Discipline,PLR,FOIA,Civil Penalty,Sec. (1040,941,720,etc.)(if applicable) (see instructions) 4980H Shared Responsibility Payment,etc.)(see instructions) RECOGNITION OF EXEMPTION UNDER SECTION 501(a) Form 1024 2019-2020 4 Specific use not recorded on 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 ► ❑ 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 return; ❑Other acts authorized: For Privacy Act and Paperwork Reduction Act Notice,see the instructions. Cat.No.11980J Form 2848(Rev.2-2020)