Vermont Department of Taxes     PO Box 429     Montpelier, VT  05601-0429

                                                                                                                           Form
   Vermont                     AUTHORIZATION TO RELEASE TAX INFORMATION
                                                                                                                   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.

 1 Taxpayer’s Name                                                           Social Security Number      Federal ID Number

   Spouse/Civil Union Partner Name                                           Social Security Number 

   Address                                                                   Telephone Number            Fax Number

   City, State, ZIP Code                                                     Email Address

   Foreign Country (if not United States)

 2 Authorized Recipient’s Name                                               Telephone Number

   Address                                                                   Fax Number

   City, State, ZIP Code                                                     Email Address

 3 Scope of Authorization.  The person designated in Section 2 is authorized to inspect and/or receive tax return information related 
   to the tax matters listed here.
           (a)                           (b)                             (c)                             (d)
    Type of Tax                          Tax Form      Year(s) or Period(s)                              Specific Tax Issue

 4 Signature of Taxpayer(s).  
   If the tax return(s) in Section 3 is a joint return, either spouse/civil union partner may sign this authorization.  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
                                                                                                                            Rev. 10/20

                                        Form 8821-VT INSTRUCTIONS

This form allows the authorized recipient designated in Section 2 to receive, inspect or discuss with the Vermont Department 
of Taxes your confidential tax information for the tax type and tax periods listed in Section 3.  
This form does not allow the authorized recipient to act on your behalf, to execute waivers, consents, or closing agreements, 
to bind you to a payment plan, or otherwise to represent you before the Vermont Department of Taxes. 
Form 8821-VT, signed by all parties, must be received by the Vermont Department of Taxes within 60 days of the date the 
taxpayer signed the form.
Revocation of Authorization  To revoke the authorization to disclose information to the recipient named in Section 2, simply 
provide a written statement to the Department indicating the tax type(s), tax matter(s) and tax period(s) for which you wish 
to revoke authorization.  If you wish to revoke all authorization, indicate the name of the person who is no longer authorized 
and instruct the Department to “remove all taxes, years and periods.”  

Section 1  Taxpayer
Individuals – Enter your name, Social Security or Taxpayer Identification Number, the address where you live, and contact 
information in the space provided.  If authorizing the release of confidential tax information for a jointly filed return, also 
enter your spouse or civil union partner’s information.
Corporations, Partnerships and other Business Entities – Enter the business name, Employer Identification Number, business 
address and contact information in the space provided.
Trusts – Enter the name, title, and address of the trustee; and the name of the trust and the trust’s Federal Identification 
Number, and contact information in the space provided.
Estates – Enter the name, title and address of the decedent’s executor/personal representative, the name and identification 
numbers of the estate, and contact information in the space provided.  Estate identification numbers are the Federal Identification 
Number and the decedent’s Social Security or Taxpayer Identification number.  

Section 2  Authorized Recipient
Enter the name, address and contact information of your authorized recipient in the space provided.  Please reference the 
authorized representative’s name as entered here in any communication with the Vermont Department of Taxes.    

Section 3  Scope of Authorization
Enter the tax type, tax form, and tax period you wish to be disclosed to your authorized recipient.  If you are a fiscal year filer, 
use the ending year and month in the YYMMDD format for the tax period.  If you have any specific tax issues you want the 
Vermont Department of Taxes to disclose beyond the tax return information, describe it in Column (d).  Examples of specific 
tax issues are tax lien, balance due on the return, tax liability, and assessment of tax.  Some sample entries for Section 3 are:
      (a)   Type of Tax          (b)   Tax Form        (c)   Year(s) or Period(s) (d)   Specific Tax Issue
      Income                     IN-111                2011 - 2013                Tax lien 
      Corporate                  CO-411                140630                     Balance due on the return
      Meals and Rooms            MR-441                2nd quarter of 2013
      Sales and Use              SU-451                August 2014                Tax liability
The authorization to disclose tax information must be more specific than “all years,” “all periods,” or “all taxes.”

Section 4  Signatures
Individuals – Sign and date the authorization.  If authorizing disclosure on a joint return, either spouse or civil union partner 
may sign the form.
Corporations – This form may be signed by an officer having legal authority to bind the corporation, a person designated 
by the board of directors or other governing body. 
Partnerships – This form may be signed by any partner who was a partner during any part of the tax period designated in 
Section 2.
Trusts and Estates – This form may be signed by the appointed guardian, executor, or administrator. 
                                                                                                                    Rev. 04/15