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Virginia Tax Power of Attorney Form

The Virginia tax power of attorney is a legal document used by the grantor to authorize the attorney-in-fact to act on his/her behalf in his/her tax related matters.

Virginia Tax Power of Attorney Form
Virginia Tax Power of Attorney Form
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
Check here if you do not want this representative to receive
copies of correspondence for the tax matter specied below
on Line 3.
Name and Address Virginia Authorized
Agent Number
A -
Phone Number ( )
Fax Number ( )
E-Mail Address
Check here if you do not want this representative to receive
copies of correspondence for the tax matter specied below
on Line 3.
The representative(s) above are authorized to represent the taxpayer(s) before the Virginia Department of Taxation for the
following tax matters:
LINE 3 Tax Matters - Enter type of tax and year(s) or period(s) or date of death if Estate Tax. Do not use a general reference such as
“All taxes”, “All years,” or “All periods.”
Virginia Tax Account Number Tax Type
Beginning Period
(MM/YYYY format)
Ending Period
(MM/YYYY format)
VIRGINIA POWER OF ATTORNEY AND
DECLARATION OF REPRESENTATIVE
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 Tax Power of Attorney Form
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