Department of Revenue Services 
State of Connecticut                                               LGL-001
(Rev. 11/22)
                                   Print Form             Power of Attorney           Clear Form
         Complete and attach LGL‑001 through myconneCT at portal.ct.gov/DRS-myconneCT. See instructions on Page 2.

Part I: Taxpayer(s) Giving a Power of Attorney to Another Person
Taxpayer’s name                                                                       Social Security Number

Spouse’s name (personal income tax or individual use tax only)                        Social Security Number

Mailing address                                                                       Connecticut Tax Registration Number

City                                             State             ZIP code           Federal Employer Identification Number

Taxpayer is: (Check box)
       Corporation       Partnership                     Sole proprietorship   Trust (other than a business trust)    Estate
       Individual        Limited liability company       Business trust        Other (specify) ____________________________________

Part II: Declaration of Person(s) Giving Power of Attorney and Powers Given 
See instructions for who may execute this power of attorney. This power of attorney revokes all previous powers of attorney on file with 
the Department of Revenue Services (DRS) for the same tax matters and years or periods covered by this power of attorney.
Any of the attorney(s)‑in‑fact are authorized, subject to revocation, to receive tax returns and tax return information as defined in Conn. 
Gen. Stat. § 12‑15, and to perform on behalf of the taxpayer(s) the following acts for the tax matters described below. The authority does 
not include the power to sign certain returns unless specifically stated below.
Check the boxes for the powers given to:
  Receive, but not to endorse and collect, checks (made payable to the taxpayer mentioned above) in payment of any refund of 
     Connecticut taxes, penalties, or interest.
  Execute waivers (including offers of waivers) of restrictions on assessment or collection of deficiencies in tax and waivers of notice 
     of disallowance of a claim for credit or refund.
  Execute or terminate consents extending the statutory period for assessment or collection of tax.
  Execute closing agreements under Conn. Gen. Stat. § 12‑2e.
  Delegate authority or to substitute another representative.
  Represent the taxpayer(s) named above before DRS.
  Sign returns. (See instructions.)
Declaration: I am the taxpayer identified in Part I, or if I am not the taxpayer identified in Part I, I have been authorized by the taxpayer to execute 
this power of attorney on behalf of the taxpayer and I am permitted by the instructions on this Form LGL‑001 to execute this power of attorney.  
I declare under penalty of law that I have examined this document (including any accompanying schedules and statements) and, to the best of 
my knowledge and belief, it is true, complete, and correct. I understand the penalty for willfully delivering a false return or document to DRS is a 
fine of not more than $5,000, or imprisonment for not more than five years, or both.  
Print name:  ____________________________________________________________   Title:   __________________________________________
Signature:  _____________________________________________________________   Date:  __________________________________________
Print name (Spouse):  ____________________________________________________
Signature (Spouse):  _____________________________________________________   Date:  __________________________________________

Part III: Power of Attorney Given To
The taxpayer(s) named above appoints the following individual(s) as attorney(s)‑in‑fact to represent the taxpayer(s) before DRS and receive 
tax returns and return information for the following tax matters. Specify all tax types and periods affected by this power of attorney with the 
understanding that this authority applies only to the tax types and periods listed below. Enter the date of death for succession and estate 
taxes. Indicate the representative to whom a copy of any notice from DRS should be sent by checking the box below. Check one box only.
                   Name                                            Address            Check One Box         Telephone Number
                                                                                                                      –    –
                                                                                                                      –    –
       Tax Type (Sales Tax, Gift Tax, etc.)                                                           Year(s) or Period(s)

                                                     Instructions 
Use LGL-001   , Power of Attorney, to authorize one or more         • A limited liability company (LLC) member if the taxpayer is 
individuals to represent you before DRS. This authorization           an LLC and has no manager or a manager if the taxpayer 
allows your representative(s) to receive and inspect confidential     is an LLC and has managers
tax information and to act on your behalf in matters before DRS.    • The sole proprietor if the taxpayer is a sole proprietorship;
Connecticut law stipulates that all official mailings will be sent  • A general partner if the taxpayer is a partnership or a 
to the taxpayer of record at the address on file with DRS. As a       limited partnership;
matter of policy, DRS also provides taxpayers with the right to     • The administrator or executor if the taxpayer is an estate;
have a copy of any notice sent to its counsel or other qualified    • The trustee if the taxpayer is a trust;
representative who has properly executed and filed this power       • If the taxpayer is a corporation, a principal officer or corporate 
of attorney with DRS for the type of tax and tax period that is the   officer (who has legal authority to bind the corporation), any 
subject of the notice. This power of attorney does not change         person who is designated by the board of directors or other 
the requirement that DRS send all official mailings directly to       governing body of the corporation, any officer or employee 
the taxpayer.                                                         of the corporation upon written request signed by a principal 
                                                                      officer of the corporation and attested to by the secretary 
How to File                                                           or other officer of the corporation, or any other person 
Complete and attach LGL‑001 through          myconneCT at             who is authorized to receive or inspect the corporation’s 
portal.ct.gov/DRS-myconneCT.                                          return or return information under IRC § 6103(e)(1)(D);
To attach LGL‑001 through a secure message in myconneCT:            • The successor, receiver, guarantor, or any assignee of 
• Log into myconneCT.                                                 the taxpayer; or
• Open the More… menu.                                              • The authorized representative of any of the above.
• Locate the    Correspondence group and click the   Send a 
                                                                    Part III: Power of Attorney Given To
  Message link.
                                                                    Provide the name, address, and telephone number of the 
• Select the account, period, message area (e.g. account, 
                                                                    person(s) designated by you to be your attorney(s)‑in‑fact. If 
  return, refund), and category.
                                                                    you are adding additional representatives to an existing power 
• Type your subject, message, and attach your LGL‑001.              of attorney, include the names of all individuals you wish to 
Part I: Taxpayer(s) Giving a Power of Attorney to                   represent you. This power of attorney revokes all previous 
                                                                    powers of attorney on file with DRS for the same tax matters 
Another Person
                                                                    and years or periods covered by this power of attorney. 
Provide the taxpayer’s name and address and either your Social 
Security Number (SSN) or Connecticut Tax Registration Number        Enter the tax type and the tax periods or tax years that are the 
and Federal Employer Identification Number. If you are a sole       subject of this power of attorney. Be specific about the type of 
proprietor, enter your name and SSN. Do not enter your trade        tax at issue (refer to the following examples):
name. Do not use your representative’s address as your own.         • Withholding tax;
Your spouse’s name is not required except for joint personal        • Income tax;
income tax or individual use tax returns.                           • Sales and use taxes;
If you are filing a joint personal income tax return and you and    • Corporation business tax;
your spouse have the same representative(s), include your           • Pass‑through entity tax;
spouse’s name, SSN, and signature in the appropriate spaces         • Admissions and dues tax;
provided. Otherwise, each spouse must file a separate LGL‑001.      • Estate tax;
Check the box that describes the taxpayer.                          • Gift tax;
                                                                    • Motor vehicle fuels tax;
Part II: Declaration of the Person Giving Power of                  • Gross earnings tax (petroleum, gas, hospital, community 
Attorney And Powers Given                                             antenna);
Any person giving a power of attorney to another person(s) must     • Cigarette tax distributor; and
sign this declaration and must check the box for each act being     • Individual use tax.
granted to the attorney‑in‑fact to perform in matters before DRS. 
If a tax matter concerns a joint return, both husband and wife      The terms years and periods can indicate various time frames.
must sign in the space provided if they wish to be represented      A tax year may be a calendar year of 1/1/22 through 12/31/22 
by the same person(s).                                              or a fiscal year of 7/1/22 through 6/30/23 for corporation tax. A tax 
Who may execute this power of attorney?                             period may have one or more monthly or quarterly periods.
• Any individual if the request is for an income tax return           Example: A sales and use tax period of 1/1/20 through 
  filed by that individual (or filed by that individual and his or    12/31/22 may contain 36 monthly or 12 quarterly periods.
  her spouse if the request is for a joint income tax return);
                                                                    Indicate the tax year(s) or tax period(s) to be covered by the 
Conn. Agencies Regs. § 12‑725‑1(b) allows an agent, or a fiduciary 
                                                                    power of attorney.
charged with the care of the person or property of the taxpayer, 
to make and sign a return only when illness, absence, minority,     For the Latest News
or other good cause prevents the person required or permitted to 
make or file a Connecticut income tax return from doing so. You     Visit the DRS website at portal.ct.gov/DRS.
must state a reason why the taxpayer cannot sign the return.

LGL‑001 Back (Rev. 11/22)