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Special Power of Attorney
for use by Individuals, Businesses, Estates and Trusts
(joint lers must each le a Power of Attorney form)
Vermont Department of Taxes, 133 State Street, Montpelier, VT 05633-1401
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
(Check all applicable boxes)
Receive the Taxpayer’s tax returns and information regarding
Taxpayer’s returns which have been filed with the Department of
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
3.Name of Agent 4. Telephone Number of Agent
5.Address of Agent
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 le with the Department of Taxes are herby revoked except:
13.Signature of Agent (person on Line 3) Date
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.
1.Name of Taxpayer (Principal) 2. Social Security Number or
Address of Taxpayer Federal ID Number or (if applicable) State ID Number
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
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