Form Pa-1 - Special Power Of Attorney For Use By Individuals, Businesses, Estates And Trusts

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Vermont Department of Taxes, 133 State Street, Montpelier, VT 05633-1401
Special Power of Attorney
F
orm
PA-1
for use by Individuals, Businesses, Estates and Trusts
(joint filers must each file a Power of Attorney form)
TAXPAYER
1. Name of Taxpayer (Principal)
2. Social Security Number or
Federal ID Number or (if applicable) State ID Number
Address of Taxpayer
AGENT
3. Name of Agent
4. Telephone Number of Agent
5. Address of Agent
6. The Taxpayer hereby appoints the above-named person as agent for the Taxpayer and authorizes said agent to perform the following acts on behalf of the
Taxpayer:
(Check all applicable boxes)
 Receive the Taxpayer’s tax returns and information regarding
 Represent the Taxpayer in appeals before the Commissioner of Taxes at
Taxpayer’s returns which have been filed with the Department of
a formal hearing if the agent is an attorney or CPA licensed to practice in
Taxes
the State of Vermont.
 Represent the Taxpayer in discussions and at informal conferences
 Prepare and file Vermont state tax returns
with Vermont Department of Taxes personnel regarding the
 Perform any legal act on the Taxpayer’s behalf with respect to the taxes
Taxpayer’s tax returns and/or liabilities
and tax periods identified below
 Negotiate the assessment and payment of tax liabilities
7. This power of attorney is effective for the following taxes and tax periods:
8. Special skills or expertise of Agent (i.e., CPA, RPA, Tax Preparer, Attorney-at-Law). If none, write “None”.
9. All prior powers of attorney on file with the Department of Taxes are herby revoked except:
SIGNATURE
10. Signature of Individual Taxpayer on Line 1
Date
11. Signature of person authorized to sign for Entity Taxpayer
Date
12. Printed name and title of person signing POA for Entity Taxpayer
ATTESTATION OF AGENT
I hereby attest that:
• I accept appointment as agent for the Taxpayer;
• I understand my duties under this Power of Attorney and under law;
• I understand that I am expected to use the skills and expertise identified above on behalf of the Taxpayer.
13. Signature of Agent (person on Line 3)
Date
Form PA-1
Rev. 09/13

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