Vermont Special Power of Attorney for use by Individuals, Businesses, Estates and Trusts

Special Power of Attorney for use by Individuals, Businesses, Estates and Trusts
Form PA-1
Vermont Department of Taxes, 133 State Street, Montpelier, VT 05633-1401

Special Power of Attorney

for use by Individuals, Businesses, Estates and Trusts
(joint filers must each file a Power of Attorney form)

Form

PA-1

TAXPAYER
	 1.	 Name of Taxpayer (Principal)	

2.	Social Security Number or

		 Address of Taxpayer		 Federal ID Number or (if applicable) State ID Number

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
Taxpayer’s returns which have been filed with the Department of
Taxes
	 Represent the Taxpayer in discussions and at informal conferences
with Vermont Department of Taxes personnel regarding the
Taxpayer’s tax returns and/or liabilities
	 Negotiate the assessment and payment of tax liabilities

	 Represent the Taxpayer in appeals before the Commissioner of Taxes at
a formal hearing if the agent is an attorney or CPA licensed to practice in
the State of Vermont.
	 Prepare and file Vermont state tax returns
	 Perform any legal act on the Taxpayer’s behalf with respect to the taxes
and tax periods identified below

	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	
	11.	 Signature of person authorized to sign for Entity Taxpayer	

Date
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

INSTRUCTIONS FOR COMPLETING VERMONT DEPARTMENT OF TAXES
SPECIAL POWER OF ATTORNEY (POA).
•	

This form may be used by individuals, businesses, estates and trusts. Joint income tax filers must each complete and file
a power of attorney form.

•	

All POA forms submitted to the Department of Taxes must comply with the requirements of chapter 123 of Title 14,
except that signatures of a witness and notary are not required.

•	

POA forms must be signed by the agent.  THE DEPARTMENT OF TAXES WILL NOT ACCEPT A POA UNLESS
SIGNED BY THE AGENT.

•	

By signing, an agent attests that he/she accepts appointment as agent and understands the duties of agent, both under the
POA and under the law.  In addition, if special skills or expertise of the agent are identifed, the agent must attest that he/
she understands that he/she is expected to use those skills and expertise on behalf of the Taxpayer.

LINE-BY-LINE INSTRUCTIONS FOR SPECIAL POA
1.	 Print the name and address of the Taxpayer.
2.	 Enter the Social Security Number of an individual
Taxpayer or Federal ID Number or (if applicable) State
ID Number of an entity Taxpayer.
3.	 Print the name of the Agent.
4.	 Print the telephone number of the Agent.
5.	 Print the address of the Agent.
6.	 Check applicable boxes if you are authorized to prepare
and file Vermont state tax returns, the returns must still
be signed by the taxpayer.
7.	 List specific tax types (i.e., “income tax”) and tax
periods (i.e., “2002”) for which Agent is authorized to

act on your behalf.   If all taxes and tax periods, write
“ALL”.
8.	 Identify any special skills or expertise of Agent which
will be exercised by agent on behalf of Taxpayer, such
as CPA, RPA, tax preparer, attorney-at-law.   If none,
write “NONE”.
9.	 List any prior Powers of Attorney on file with the                                  
Department of Taxes which are NOT revoked.
10.	 Signature of person on Line 1 if an individual Taxpayer.
11.	 Signature of person signing for an entity Taxpayer.
12.	 Print the name and title of person signing for an entity
taxpayer.
13.	 Signature of Agent and date agent signed.