Form Pa-1 - Special Power Of Attorney (Business, Estate, Or Trust) Page 4

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LINE BY LINE INSTRUCTIONS FOR SPECIAL POA
(Business, Estate, or Trust)
1. Print name of business, estate, or trust.
9. List specific tax types (i.e., “Corporate income tax”) for
which Agent is authorized to act on Principal’s behalf. If
2. Print Federal Identification Number or State Identifica-
all tax types, write “ALL”.
tion Number (if applicable) of principal.
10. List any prior Powers of Attorney on file with the
3. Print name of Agent.
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 instruc-
13. Signature of person named on Line 11.
tions.
14. Date POA is signed.
7. State any special skills or expertise of Agent which will
be exercised by agent on behalf of Principal, such as
15. Print name of witness.
CPA, RPA, tax preparer, attorney-at-law. If none, write
16. Signature of witness and date witness signed POA.
“NONE”.
17. To be filled out and signed by Notary Public.
8. List specific tax periods (i.e., “2002”) for which Agent
is authorized to act on Principal’s behalf. If all tax peri-
18. Signature of Agent and date agent signed.
ods, write “ALL”.

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