Form PA-1 Fillable Special Power of Attorney for use by Individuals, Businesses, Estates and Trusts
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

2002 ) 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 income (Check all applicable boxes) (joint filers must each file a Power of Attorney form) 1 Name of Taxpayer (Principal) 2 Social Security Number or 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 13 Signature of Agent (person on Line 3) Date 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 file with the Department of Taxes are herby revoked except: accepts addition address Address of Taxpayer Federal ID Number or (if applicable) State ID Number agent agent agent agent Agent Agent Agent AGENT and tax periods identified below applicable applicable) appointment attest ATTESTATION OF AGENT attests attorney attorney at law authorized behalf behalf boxes businesses chapter Check complete comply Department duties Enter entity entity estates except exercised expected expertise expertise Federal filers Form PA 1 forms he/she I hereby attest that: identifed Identify income individual individuals INSTRUCTIONS FOR COMPLETING VERMONT DEPARTMENT OF TAXES Joint LINE BY LINE INSTRUCTIONS FOR SPECIAL POA Negotiate the assessment and payment of tax liabilities notary number Number Perform any legal act on the Taxpayer s behalf with respect to the taxes periods person person power Powers prepare Prepare and file Vermont state tax returns preparer Print Print Print prior Receive the Taxpayer s tax returns and information regarding Represent the Taxpayer in appeals before the Commissioner of Taxes at Represent the Taxpayer in discussions and at informal conferences required requirements returns Rev 09/13 revoked Security Signature Signature signatures signed signed SIGNED BY THE AGENT signing signing skills skills Social special SPECIAL POWER OF ATTORNEY (POA) Special Power of Attorneyfor use by Individuals Businesses Estates and Trusts specific state still submitted tax ) taxes Taxes Taxes the State of Vermont taxpayer Taxpayer Taxpayer Taxpayer Taxpayer Taxpayer s returns which have been filed with the Department of a formal hearing if the agent is an attorney or CPA licensed to practice in Taxpayer s tax returns and/or liabilities Taxpayer: telephone THE DEPARTMENT OF TAXES WILL NOT ACCEPT A POA UNLESS 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 those title trusts types under understands Vermont Vermont Department of Taxes 133 State Street Montpelier VT 05633 1401 which which with Vermont Department of Taxes personnel regarding the witness write