Special Power Of Attorney (Page 3 of 5) in pdf

Special Power Of Attorney Page 3

Page 3 of 5

Vermont Department of Taxes

Special Power of Attorney

(USE VALUE APPRAISAL PROGRAM)

___________________________________________________________, Social Security/Federal

(1.

Name)

I.D. number ___________________________, hereby appoints ___________________________

(2. ID#)

(3. Name of Agent)

______________________________________________________________________________

(4. Address)

____________________________________ as its agent and authorizes said agent to perform the

(5.

Telephone Number)

following acts on its behalf as they relate to the real property or interest herein owned by me in

______________________________, Vermont:

(6. Check Applicable Boxes)

Application (NOTE: If this form is used to authorize an agent to sign the application for the

landowner, it must be recorded in the land records of the municipality)

Forest Management Plan

Forest Management Activity Report

Notice of Development or Discontinuance

Other (specify):

__________________________________________________________________

Special skills or expertise of Agent (e.g., Forester, CPA, Attorney-at-law).

If none, state “None.” __________________________________________________________

___________________________________________________________________________

All prior owners of attorney on file with the Department of Forests, Parks and Recreation or the

Division of Property Valuation and Review are hereby revoked except:

___________________________________________________________________________

_____________________________________

_________________________________

9. Printed name of person signing POA

11. Date

______________________________________________

__________________________________________

10. Signature of Taxpayer or Authorized Representative

12. Title of person signing POA

Special Power Of Attorney Page 3