Vermont Special Power of Attorney for use by Individuals, Businesses, Estates and Trusts

Special Power of Attorney for use by Individuals, Businesses, Estates and Trusts
Form PA-1
Vermont Department of Taxes, 133 State Street, Montpelier, VT 05633-1401

Special Power of Attorney (POA)

Form

PA-1

for use by Individuals, Businesses, Estates and Trusts
(Joint filers must each file a Power of Attorney form)
TAXPAYER
	

1. Name of Taxpayer (Principal)		

	

Address of Taxpayer		

2. Social Security Number or		 FEIN or State ID Number
City	

State	

ZIP Code

3. Email Address

AGENT
	

4. Name of Agent			

	

Address of Agent	

5. Telephone Number of Agent	
City	

State	

ZIP Code 	

6. Email Address

	 7.	 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 or agricultural/forestland Current Use enrollment
which have been filed with the Department of Taxes

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.

Represent the Taxpayer in discussions and at informal conferences with
Vermont Department of Taxes personnel regarding the Taxpayer’s tax
returns and/or liabilities or Current Use enrollment

Prepare and file Vermont state tax returns and forms

Negotiate the assessment and payment of tax liabilities

Perform any legal act on the Taxpayer’s behalf with respect
to the taxes and tax periods identified below

	8.	 This power of attorney is effective for the following taxes and tax periods:	
	9.	 Special skills or expertise of Agent (i.e., CPA, RPA, Tax Preparer, Attorney-at-Law, Consulting Forester). If none, write “None”.		
	10.	 Prior Power of Attorney forms on file with the Department of Taxes:
are hereby all revoked
remain valid
Other. Specify: ____________________________________________________________

SIGNATURE

	11.	 Signature of Individual Taxpayer on Line 1	
	12.	 Signature of person authorized to sign for Entity Taxpayer	

Date
Date	

13.	 Printed name and title of person signing POA for Entity Taxpayer

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.
	14.	 Signature of Agent (person on Line 4)	

Date

Form PA-1
Page 1 of 1
Rev. 06/25

FORM PA-1 Instructions
Special Power of Attorney (POA)
General Instructions
Please use BLUE or BLACK ink only.
This form may be used by individuals, businesses, estates and trusts. Joint income tax filers must each complete
and file a power of attorney form.
All POA forms submitted to the Department of Taxes must comply with the requirements of 14 V.S.A.,
Chapter 127, except that signatures of a witness and notary are not required.
POA forms must be signed by the Agent. THE DEPARTMENT OF TAXES WILL NOT ACCEPT A POA UNLESS
SIGNED BY THE AGENT.
By signing, an Agent attests they accept appointment as Agent and understands the duties of Agent, both under
the POA and under the law. In addition, if special skills or expertise of the Agent are identified, the
Agent must attest they understand that they are expected to use those skills and expertise on behalf
of the Taxpayer.

Line-by-Line Instructions
Line 1	

Print the name and address of the Taxpayer.

Line 2	

Enter the Social Security Number of an individual Taxpayer or Federal ID Number or (if applicable)
State ID Number of an entity Taxpayer.

Line 3	

Print the email address of the Taxpayer.

Line 4	

Print the name and address of the Agent.

Line 5	

Enter the telephone number of the Agent.

Line 6	

Print the email address of the Agent.

Line 7	

Check applicable boxes if you are authorized to prepare and file Vermont state tax returns. The
returns must still be signed by the taxpayer.

Line 8	

List specific tax types (e.g., “income tax”) and tax periods (e.g., “2024”) for which the Agent is
authorized to act on your behalf. If all taxes and tax periods, write “ALL”.

Line 9	

Identify any special skills or expertise of the Agent which will be exercised by the Agent on behalf
of the Taxpayer, such as CPA, RPA, tax preparer, attorney-at-law, consulting forester. If none, write
“NONE”. If for Current Use purposes, enter the YEAR.

Line 10	

If you have prior POA forms on file with the Department, please indicate if you would like them
revoked or if they remain valid.

Line 11	

Signature of person on Line 1 if an individual Taxpayer.

Line 12	

Signature of person signing for an entity Taxpayer.

Line 13	

Print the name and title of person signing for an entity Taxpayer.

Line 14	

Signature of Agent and date Agent signed.
Form PA-1 Instructions
Page 1 of 1
Rev. 06/25