Vermont Tax Power of Attorney FormVermont Tax Power of Attorney Form
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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 o