VERMONT DEPARTMENT OF LABOR
           ATTN: Employer Services                                                 VT Unemployment Account Number
                       P.O. Box 488
           Montpelier, VT  05601-0488
                                                                                   Federal Identification Number
                 Phone: 802-828-4344
                    Fax: 802-828-4248
           Limited Power of Attorney and                                                    Client Number
           Tax Information Authorization
           (Business, Estate or Trust)

Taxpayer's Legal Business Name: ____________________________________________________________________
Trade Name(s): ___________________________________________________________________________________
hereby appoints ______________________________________ as its agent to perform the following acts on its behalf:

This Limited Power of Attorney form is effective for the period beginning ________________ and will remain in effect until
this department is otherwise notified.                         (Quarter/Year)

(check all that apply):
     Receive, prepare and file new and amended Vermont Employer's Quarterly Wage & Contribution Report forms.
     Obtain from and provide to this agency information regarding its returns filed for periods on or after the date below.
     Discuss matters as they pertain to the rate assignments and experience rating.

Address in Fact: _________________________________
(C-101 Forms, Rate ________________________________
Notices, Statements) ________________________________
Telephone No.: ___________________________________

Please specify the client address where benefit claim related information should be mailed. 
Client Address: _________________________________
(Only Benefit Claim  _______________________________
Related Information) ______________________________
Telephone No.: _________________________________

It applies only to the items which have been selected above as they pertain to the Unemployment Insurance Tax and/or
Benefit related matters for the client.

This limited Power of Attorney revokes all prior Powers of Attorney on file with the Vermont Department of Labor.

________________________________________        ________________________________________       
Person Completing and Signing Power of Attorney Date
________________________________________             ______________________________________
Signature                                            Title of Person Signing Power of Attorney

                                       (PLEASE COMPLETE PAGE 2)
                                                                                                         C-50 (04 6/1 )

AFFIRMATION OF WITNESS

I, ______________________________ affirm that _________________________________ appeared to be of sound
mind and free from duress at the time this Limited Power of Attorney was signed, and that (s)he affirmed that (s)he was
aware of the nature of this document and signed it freely and voluntarily.

_________________________________________           ______________________
Signature of Witness (Cannot be same as Notary)     Date

                                  FOR USE BY NOTARY STATE OF_____________________________________
                                                    COUNTY OF  __________________________________, SS.
At _________________________ on the _______ day of  __________________________ personally appeared
___________________________________ who acknowledged this Instrument and signed by him/her as his/her free act and
deed, and before me,
________________________________________ .          My Commission expires: ____________________________
Signature of Notary Public

ATTESTATION OF AGENT

I, _____________________________________ do hereby attest that I accept appointment as agent for

_______________________________________ (hereafter "principal") and:

that I understand my duties under this Limited Power of Attorney and under the law;

that I understand that I have a duty for the principal as to the specific transactions and types of transactions if
expressly required to do so in this Limited Power of Attorney;

that I hereby specifically acknowledge and accept such duties to act in signing this Limited Power of Attorney;

in the case of such a duty to act, my agreement to act on or behalf of the principal is enforceable against me
regardless of whether there is any consideration to support a contractual obligation;

that I understand and acknowledge in signing this Limited Power of Attorney, that if I have been selected as agent
with the expectation that I have special skills or expertise I will use those skills on behalf of the principal.

_____________________________________________                 _____________________________
Signature of Agent                                            Date Signed