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Special Power Of Attorney (Business, Estate, Or Trust) Form. This is a Vermont form and can be use in Miscellaneous Statewide.
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Tags: Special Power Of Attorney (Business, Estate, Or Trust), Vermont Statewide, Miscellaneous
Vermont Department of Taxes
133 State Street
Montpelier, VT 05633-1401
Principal
Special Power of Attorney
(Business, Estate, or Trust)
1 Name of Business, Estate, or Trust
2 Federal ID Number / State ID Number (if applicable)
Agent
3 Name of Agent
6
4 Telephone Number of Agent
5 Address of Agent
The principal named above hereby appoints the above-named agent as its agent and authorize said agent
to perform the following acts on its behalf:
(Check all applicable boxes)
Prepare, sign, and file Vermont state tax
returns
Receive its tax returns and information
regarding its returns which have been filed
with the Department of Taxes
Represent it in informal discussions with
Vermont Department of Taxes personnel
regarding its tax returns and/or liabilities
Negotiate the assessment and payment of
tax liabilities
Represent it in appeals before the Commissioner
of Taxes, including informal conferences and
formal hearings
Perform any and all acts on its behalf with respect to the following tax matters:
____________________________________
____________________________________
____________________________________
____________________________________
7 Special skills or expertise of Agent (i.e., CPA, RPA, Tax Preparer, Attorney-at-Law). If none, write “None”.
8 This power of attorney is effective for the following tax periods:
9 It applies to the following taxes:
10 All prior powers of attorney on file with the Department of Taxes are hereby revoked except:
11 Printed name of the person signing POA for The Principal
13
Signature of Principal or Authorized Representative (person on Line 11)
12 Title of person signing POA
14 Date
CONTINUED ON BACK
Form PA-1(Bus.)
Rev. 1/07
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AFFIRMATION OF WITNESS
I affirm that the principal appeared to be of sound mind and free from duress at the time this power of attorney
was signed, and that he/she affirmed that he/she was aware of the nature of this document and signed it
freely and voluntarily.
15 Print name of Witness
16
Signature of Witness for person signing on Line 13
17
Date
FOR USE BY NOTARY
State of ______________________________
County of ____________________________ , SS.
At ___________________________________
on the _______ day of ________________, 20_____
City
Day
Month
Year
personally appeared ________________________________ who acknowledged this Instrument signed by
Name from Line 11
him/her to be his/her free act and deed, and the free act and deed of ______________________________
Name from Line 1
Before me _________________________________
My Commission Expires: _____________________
ATTESTATION OF AGENT
I hereby attest that I accept appointment as agent for the principal and:
that I understand my duties under this power of attorney and under the law;
that I understand that I have a duty to act for the principal as to specified transactions or types of transactions if expressly required to do so in this power of attorney;
that I hereby specifically acknowledge and accept such duties to act in signing this power of attorney;
in the case of such a duty to act, my agreement to act on behalf of the principal is enforceable against me
regardless of whether there is any consideration to support a contractual obligation;
that I understand and acknowledge in signing this power of attorney, that if I have been selected as agent
with the expectation that I have special skills or expertise I will use those skills on behalf of the principal.
18
Signature of Agent (person on Line 3)
Date
Form PA-1(Bus.)
rev. 1/07
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INSTRUCTIONS FOR COMPLETING VERMONT DEPARTMENT OF TAXES
SPECIAL POWER OF ATTORNEY (POA).
FOR BUSINESS, ESTATE, OR TRUST
A new law (14 V.S.A. Chapter 123) concerning POAs became effective July 1, 2002. All POAs submitted to the
Department of Taxes beginning July 1, 2002 must comply with the new law. However, any POA executed prior to July 1,
2002 and valid under law then in effect will continue to be valid.
The most important changes concern the execution of a POA. A POA filed July 1, 2002 or later which does not comply
with the new execution requirements will not be valid. In order to be valid, every Vermont Department of Taxes Special
POA must meet all of the following execution requirements:
1) POAs must be signed by the principal in the presence of at least one witness and acknowledged before a notary public,
who cannot be the same person as the witness. The person named as agent cannot serve as witness or notary. THE
DEPARTMENT OF TAXES WILL NOT ACCEPT POAS WHERE THE WITNESS AND NOTARY ARE
THE SAME PERSON.
2) The witness must affirm that the principal appeared to be of sound mind and free from duress at the time of signing and
that the principal affirmed that he/she was aware of the nature of the document and signed it freely and voluntarily.
3) POAs also must be signed by the agent. This does not have to happen at the same time the principal signs, but must
happen before the POA can be used. THE DEPARTMENT OF TAXES WILL NOT ACCEPT POAS UNLESS SIGNED BY THE AGENT.
4) When signing, an agent must attest that he/she accepts appointment as agent and understands the duties of agent, both
under the POA and under the law. In addition, there are two optional provisions, which, if chosen in a POA, require
attestation by agents. First, if a POA gives an agent a duty to act as to the powers given (as opposed to merely the
authority to act), the agent must attest that he/she understands that duty. Second, if the agent is expected to use special
skills or expertise on behalf of the principal, he/she must so attest.
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LINE BY LINE INSTRUCTIONS FOR SPECIAL POA
(Business, Estate, or Trust)
1. Print name of business, estate, or trust.
2. Print Federal Identification Number or State Identification Number (if applicable) of principal.
9. List specific tax types (i.e., “Corporate income tax”) for
which Agent is authorized to act on Principal’s behalf. If
all tax types, write “ALL”.
3. Print name of Agent.
10. List any prior Powers of Attorney on file with the
Vermont Department of Taxes which are NOT revoked.
4. Print telephone number of Agent.
11. Print name of person signing POA for the Principal.
5. Print address of Agent.
12. Title of person signing POA.
6. Check applicable boxes and/or provide specific instructions.
13. Signature of person named on Line 11.
7. State any special skills or expertise of Agent which will
be exercised by agent on behalf of Principal, such as
CPA, RPA, tax preparer, attorney-at-law. If none, write
“NONE”.
8. List specific tax periods (i.e., “2002”) for which Agent
is authorized to act on Principal’s behalf. If all tax periods, write “ALL”.
14. Date POA is signed.
15. Print name of witness.
16. Signature of witness and date witness signed POA.
17. To be filled out and signed by Notary Public.
18. Signature of Agent and date agent signed.
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