Form 8821-Vt - Authorization To Release Tax Information - 2011
ADVERTISEMENT
1
2Vermont Department of Taxes
PO Box 429
Montpelier, VT 05601-0429
F
orm
V
AUTHORIZATION TO RELEASE TAX INFORMATION
ermont
8821-VT
This form authorizes release of your tax information to an authorized recipient. This is NOT a Power of Attorney
and does not authorize recipient to act on your behalf or make binding agreements for you.
Taxpayer’s Name
Social Security Number
Federal ID Number
1
Spouse/Civil Union Partner Name
Social Security Number
Address
Telephone Number
Fax Number
City, State, ZIP Code
E-mail Address
Authorized Recipient’s Name
Telephone Number
2
Address
Fax Number
City, State, ZIP Code
E-mail Address
Scope of Authorization. The person designated in Section 2 is authorized to inspect and/or receive tax return information related
3
to the tax matters listed here.
(a)
(b)
(c)
(d)
Type of Tax
Tax Form
Year(s) or Period(s)
Specific Tax Issue
Signature of Taxpayer(s).
4
If the tax return(s) in Section 3 is a joint return, either spouse/civil union partner may sign this authorization. Otherwise, see
instructions. If you are a corporate officer, partner, guardian, executor, receiver, administrator, or trustee signing on behalf of the
taxpayer, your signature constitutes a certification that you have the authority to execute this form on behalf of the taxpayer.
IF NOT SIGNED AND DATED, THIS AUTHORIZATION TO RELEASE TAX INFORMATION WILL BE RETURNED.
Signature
Date
Print Name
Title (if applicable)
Signature
Date
Print Name
Form 8821-VT
(08/11)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial