Form Par 101 - Virginia Power Of Attorney And Declaration Of Representative
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1
2Form PAR 101
Virginia Tax
P. O. Box 1115
Virginia Power of Attorney and
Richmond, VA 23218-1115
Declaration of Representative
Individual fax: (804) 254-6113
Business fax: (804) 254-6111
This is a legal document.
If this Form PAR 101, Power of Attorney and Declaration of Representative is not signed and dated, lacks complete
information, or is illegible, it will be denied.
Asterisks denote required fields. Read the instructions carefully before completing this form.
1. Taxpayer Information
Taxpayer Name (Individual, Business, or Fiduciary)*
SSN, ITIN, or FEIN*
Spouse Name (For joint representation only. See instructions.)
Spouse SSN or ITIN
Address*
Daytime Telephone Number
(
)
Address
Alternative Telephone Number
(
)
City*
State*
ZIP Code*
Email Address
2. Maintain or Revoke Prior Authorization
Maintain authorization for the agent listed below.
This form automatically revokes all earlier powers of attorney on file with Virginia
Tax for the same tax matters covered by this form.
(Specify agent name, address, ZIP Code, and date granted. Attach copy of the power of attorney form.)
Revoke prior authorization(s).
To revoke a prior power of attorney without naming another representative, send a copy of the power
of attorney form to Virginia Tax at the address above and write “REVOKE” across the top. If you do not have a copy of the power of attorney
form, provide the agent’s name, address, ZIP Code, and date granted:
3. Tax Matters – Taxable years or periods may not extend more than 3 years into the future. You must
designate at least one tax type and taxable year period.*
Annual Income Taxes Only – Individual, Corporate, Pass-through Entity, Fiduciary, or Estate Tax Type
Tax Type
Taxable Years
Do Not Enter “All Years” – Must be Specific
Business, Excise, Commodity, and Other Taxes
Tax Type
15-Character Virginia Tax Account
Do Not Enter “All Periods” – Must be Specific
Number
Beginning Period
Ending Period
REQUIRED: See Instructions
(MM/YYYY)
(MM/YYYY)
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