Virginia Tax Power of Attorney FormVirginia Tax Power of Attorney FormVirginia Tax Power of Attorney Form
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DEPARTMENT OF TAXATION
P.O. BOX 1115
RICHMOND, VA 23218-1115
Individual Fax: 804-254-6113
Business Fax: 804-254-6111

FORM PAR 101

VIRGINIA POWER OF ATTORNEY AND
DECLARATION OF REPRESENTATIVE

LINE 1 Taxpayer Information - Taxpayer(s) must furnish the information requested and sign and date this form.
Taxpayer Name(s) and Address

Your Social Security Number

Spouse's Social Security
Number

Federal Employer ID Number
(if applicable)

Daytime Telephone Number

(

)

E-mail Address

LINE 2 Representative(s) - The representative(s) must sign and date this form. The two representatives listed here will receive written
copies of correspondence as discussed in the Instructions. Only individuals may be named as representatives. See the instructions for
additional information.
Name and Address

Virginia Authorized
Agent Number

A-

Phone Number

(

)

 Fax Number

(

)

 E-Mail Address

Name and Address

Check here if you do not want this representative to receive
copies of correspondenc