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Connecticut Tax Power of Attorney Form (LGL-001)

Connecticut Tax Power of Attorney Form (LGL-001) can be used to designate someone to represent you in front of the Connecticut Department of Revenue Services. The person you designate, usually a trusted accountant or tax advisor, will be able to file returns on your behalf, obtain information on your behalf or ask the agency representatives for answers on your behalf. This is useful when you are unavailable when returns are due, or need help figuring out the tax system.

How to Write

1 – Obtain The Necessary Paperwork

The right hand side of this page will present three buttons displaying the different file versions of this form. Select one to open or download this form.

2 – Part I: Taxpayer(s) Giving A Power Of Attorney To Another Person

This form will present a Table so that you may enter the requested information in an organized manner. To begin, enter the Name of the Taxpayer granting another entity Principal Power in the box cell labeled “Taxpayer’s Name.” The next cell on this row requires the Social Security Number of the Principal Taxpayer.

If the Principal Taxpayer filed jointly with a spouse, then he or she will need to have these items (Name and Social Security Number) reported in the second row.

The first column of the third and fourth row must have the Principal Taxpayer’s Mailing Address and City/State/Zip Code documented (respectively).

The second column of the third and fourth row should have the Taxpayer’s Connecticut Tax Registration Number and Federal Employer Identification Number entered.

Next, the entity type of the Taxpayer must be determined and reported. This may be done in the area below the table following the words “Taxpayer is.” Here, you must mark the check box corresponding to the most applicable entity description. The Taxpayer may be a Corporation, Partnership, Trust (excluding Business Trusts), Estate, Individual, Limited Liability Company, Business Trust, or another type of entity. If the Taxpayer’s entity type is not listed, then mark the check box designated as “Other” and enter the Entity Type on the blank line provided.

3 – Part II: Declaration Of Person(s) Giving Power of Attorney And Powers Given

The text provided in this section must be read and understood by the Principal and the Attorney-in-Fact being granted power. There will be a specific area furnished to specify which Principal Power(s) the Attorney-in-Fact may yield. Locate the list of statements with check boxes on this page, then mark the check box corresponding to each Tax Matter and Action the Principal is granting Power over to the Attorney-in-Fact in.

If the Attorney-in-Fact may receive checks on behalf of the Principal, then mark the first box.

If the Attorney-in-Fact may execute waivers of restrictions regarding an assessment or collection of deficiencies, then mark the second box.

If the Principal wishes to grant the Agent the power to Execute/Terminate the consents required to extend statutory periods for assessment or collections.

If the Principal wishes to grant the Attorney-in-Fact the Power to Execute closing agreements under Conn. Stat. 12-2e, then mark the fourth box.

If the Attorney-in-Fact or Agent may delegate Authority or Name a Substitute Representative, then mark the fifth box.

In order for the Attorney-in-Fact to represent the Principal before the Department of Revenue Services then mark the sixth box.

If the Attorney-in-Fact may sign returns on behalf of the Principal the seventh box must be marked.

The Principal Taxpayer must read the “Declaration” paragraph then present his or her Printed Name and Title using the two blank spaces in the first line after this paragraph.

The Principal Taxpayer must Sign his or her Name then enter the Date of Signature on the two blank spaces in the second line after the “Declaration” paragraph.

4 – Part III: Power of Attorney Given To

The final section of this form will call for the Identity and Contact Information for each Attorney-in-Fact who is being appointed with Principal Power. Additionally, the Tax Types and Periods the Attorney-in-Fact may use Principal Authority in must be recorded as well.

Locate the first table. You may name two Attorney-in-Facts to have Principal Authority using this table. To begin report each Agent’s Name, Address, and Telephone Number. Make sure to check the box provided to activate this entity to the Tax Matters that will be described.

The second table will have two columns. The first column, “Tax Type (Sales Tax, Gift Tax, etc.),” will require a definition to the subjects/forms/correspondence the Attorney-in-Fact may utilize Principal Authority over. The next column, “Year(s) or Period(s),” will supply a space for the exact Time Period the Attorney-in-Fact may exert Principal Power in the corresponding Tax Matter listed on that row.

5 – Deliver To The Appropriate Parties

Obtain the Mailing Address, Fax, Number, or Email of the Connecticut Department of Revenue Services Employee who will be expected to deal with the Attorney-in-Fact representing the Principal. Make sure this party is aware of this document and deliver a copy as per the Connecticut Department of Revenue Services Employee’s instructions.


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