The Vermont Statutes Online

Title 14 : Decedents Estates and Fiduciary Relations

Chapter 127 : Vermont Uniform Power of Attorney Act

Subchapter 003 : STATUTORY FORMS

• § 4051. Statutory form power of attorney

  A document substantially in the following form may be used to create a statutory form power of attorney that has the meaning and effect prescribed by this chapter.

  VERMONT STATUTORY FORM POWER OF ATTORNEY IMPORTANT INFORMATION

  This power of attorney authorizes another person (your agent) to make decisions concerning your property for you (the principal). Your agent will be able to make decisions and act with respect to your property (including your money) whether or not you are able to act for yourself. The meaning of authority over subjects listed on this form is explained in the Vermont Uniform Power of Attorney Act, 14 V.S.A. chapter 127.

  This power of attorney does not authorize the agent to make health-care decisions for you.

  You should select someone you trust to serve as your agent. Unless you specify otherwise, generally the agent’s authority will continue until you die or revoke the power of attorney or the agent resigns or is unable to act for you. Your agent is entitled to reasonable compensation unless you state otherwise in the Special Instructions.

  This form does not revoke powers of attorney previously executed by you unless you initial the introductory paragraph under DESIGNATION OF AGENT that all previous powers of attorney are revoked.

  This form provides for designation of one agent. If you wish to name more than one agent, you may name a coagent in the Special Instructions. Coagents are not required to act together unless you include that requirement in the Special Instructions.

  If your agent is unable or unwilling to act for you, your power of attorney will end unless you have named a successor agent. You may also name a second successor agent.

  This power of attorney becomes effective immediately unless you state otherwise in the Special Instructions.

  If you have questions about the power of attorney or the authority you are granting to your agent, you should seek legal advice before signing this form.

  DESIGNATION OF AGENT

  I _______________________________________ (Name of Principal) ( ) revoke all previous powers of attorney and name the following person as my agent:

  
  

  Name of Agent: _______________________________________

  
  

  Agent’s Address: _______________________________________________________________________

  
  

  Agent’s Telephone Number: _______________________________________

  
  

  DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)

  
  

  If my agent is unable or unwilling to act for me, I name as my successor agent:

  
  

  Name of Successor Agent: _______________________________________

  
  

  Successor Agent’s Address: _______________________________________________________________________

  
  

  Successor Agent’s Telephone Number: _______________________________________

  
  

  If my agent is unable or unwilling to act for me, I name as my second successor agent:

  
  

  Name of Second Successor Agent: _______________________________________

  
  

  Second Successor Agent’s Address: _______________________________________________________________________

  
  

  Second Successor Agent’s Telephone Number: _______________________________________

  
  

  GRANT OF GENERAL AUTHORITY

  
  

  I grant my agent and any successor agent general authority to act for me with respect to the following subjects as defined in the Vermont Uniform Power of Attorney Act, 14 V.S.A. chapter 127, together with the incidental powers enumerated in section 4033 of that chapter.

  
  

  (STRIKE THROUGH each subject you DO NOT want to include in the agent’s general authority.)

  
  

  Real Property

  
  

  Tangible Personal Property

  
  

  Stocks and Bonds

  
  

  Commodities and Options

  
  

  Banks and Other Financial Institutions

  
  

  Operation of Entity or Business

  
  

  Insurance and Annuities

  
  

  Estates, Trusts, and Other Beneficial Interests

  
  

  Claims and Litigation

  
  

  Personal and Family Maintenance

  
  

  Benefits from Governmental Programs or Civil or Military Service

  
  

  Retirement Plans

  
  

  Taxes

  
  
  
  

  GRANT OF SPECIFIC AUTHORITY (OPTIONAL)

  
  

  My agent MAY NOT do any of the following specific acts for me UNLESS I have INITIALED the specific authority listed below:

  
  

  (CAUTION: Granting any of the following will give your agent the authority to take actions that could significantly reduce your property or change how your property is distributed at your death. INITIAL ONLY the specific authority you WANT to give your agent.)

  
  

  ( ) An agent who is not an ancestor, spouse, or descendant may exercise authority under this power of attorney to create in the agent or in an individual to whom the agent owes a legal obligation of support an interest in my property whether by gift, rights of survivorship, beneficiary designation, disclaimer, or otherwise

  
  

  ( ) Create, amend, revoke, or terminate an inter vivos, family, living, irrevocable, or revocable trust

  
  

  ( ) Consent to the modification or termination of a noncharitable irrevocable trust under 14A V.S.A. § 411

  
  

  ( ) Make a gift, subject to the limitations of 14 V.S.A. § 4047 (gifts) and any special instructions in this power of attorney

  
  

  ( ) Consent to the modification or termination of a noncharitable irrevocable trust under 14A V.S.A. § 411

  
  

  ( ) Create, amend, or change a beneficiary designation

  
  

  ( ) Waive the principal’s right to be a beneficiary of a joint and survivor annuity, including a survivor benefit under a retirement plan

  
  

  ( ) Exercise fiduciary powers that the principal has authority to delegate

  
  

  ( ) Authorize another person to exercise the authority granted under this power of attorney

  
  

  ( ) Disclaim or refuse an interest in property, including a power of appointment

  
  

  ( ) Exercise authority with respect to elective share under 14 V.S.A. § 319

  
  

  ( ) Exercise waiver rights under 14 V.S.A. § 323

  
  

  ( ) Exercise authority over the content and catalogue of electronic communications and digital assets under 14 V.S.A. chapter 125 (Vermont Revised Uniform Fiduciary Access to Digital Assets Act)

  
  

  ( ) Exercise authority with respect to intellectual property, including, without limitation, copyrights, contracts for payment of royalties, and trademarks

  
  

  ( ) Convey, or revoke or revise a grantee designation, by enhanced life estate deed pursuant to 27 V.S.A. chapter 6 or under common law.

  
  
  

  LIMITATION ON AGENT’S AUTHORITY

  
  

  An agent who is not my ancestor, spouse, or descendant MAY NOT use my property to benefit the agent or a person to whom the agent owes an obligation of support unless I have included that authority in the Special Instructions.

  
  

  WHEN POWER OF ATTORNEY EFFECTIVE

  
  

  This power of attorney becomes effective when executed unless the principal has initialed one of the following:

  
  

  ( ) This power of attorney is effective only upon my later incapacity. OR

  
  

  ( ) This power of attorney is effective only upon my later incapacity or unavailability. OR

  
  

  ( ) I direct that this power of attorney shall become effective when one or more of the following occurs:

  
  

  _________________________________________

  
  

  _________________________________________

  
  

  _________________________________________

  
  

  _________________________________________

  
  

  _________________________________________

  
  

  _________________________________________

  
  

  _________________________________________

  
  

  EFFECTIVE DATE

  
  

  This power of attorney is effective immediately unless I have indicated or stated otherwise in the section above entitled When Power of Attorney Effective or in the section below entitled Special Instructions.

  
  

  SPECIAL INSTRUCTIONS (OPTIONAL)

  
  

  You may give special instructions on the following lines:

  
  

  _________________________________________

  
  

  _________________________________________

  
  

  _________________________________________

  
  

  _________________________________________

  
  

  _________________________________________

  
  

  _________________________________________

  
  

  _________________________________________

  
  
  
  
  
  

  NOMINATION OF GUARDIAN (OPTIONAL)

  
  

  If it becomes necessary for a court to appoint a guardian of my estate or a guardian of my person, I nominate the following person(s) for appointment:

  
  

  Name of Nominee for [conservator or guardian] of my estate: _________________________________________

  
  

  Nominee’s Address: _________________________________________

  
  

  Nominee’s Telephone Number: _________________________________________

  
  

  Name of Nominee for guardian of my person: _________________________________________

  
  

  Nominee’s Address: _________________________________________

  
  

  Nominee’s Telephone Number: _________________________________________

  
  

  RELIANCE ON THIS POWER OF ATTORNEY

  
  

  Any person, including my agent, may rely upon the validity of this power of attorney or a copy of it unless that person knows it has terminated or is invalid. Unless expressly stated otherwise, this power of attorney is durable and shall remain valid if I become incapacitated or unavailable.

  
  

  SIGNATURE AND ACKNOWLEDGMENT

  
  

  Your Name Printed: _________________________________________

  
  

  Your Address: _________________________________________

  
  

  Your Telephone Number: _________________________________________

  
  

  State of: _________________________________________

  
  

  County of: _________________________________________

  
  

  This document was acknowledged before me on: (Date)_________________________________________

  
  

  by . (Name of Principal)_________________________________________

  
  

  (Seal, if any): _________________________________________

  
  

  Signature of Notary: _________________________________________

  
  

  My commission expires: _________________________________________

  
  

  IMPORTANT INFORMATION FOR AGENT

  
  

  Agent’s Duties

  When you accept the authority granted under this power of attorney, a special legal relationship is created between you and the principal. This relationship imposes upon you legal duties that continue until you resign or the power of attorney is terminated or revoked. You must:

  (1) do what you know the principal reasonably expects you to do with the principal’s property or, if you do not know the principal’s expectations, act in the principal’s best interests;

  (2) act in good faith;

  (3) do nothing beyond the authority granted in this power of attorney; and

  (4) disclose your identity as an agent whenever you act for the principal by writing or printing the name of the principal and signing your own name as “agent” in the following manner: (Principal’s Name) by (Your Signature) as Agent.

  Unless the Special Instructions in this power of attorney state otherwise, you must also:

  (1) act loyally for the principal’s benefit;

  (2) avoid conflicts that would impair your ability to act in the principal’s best interest;

  (3) act with care, competence, and diligence;

  (4) keep a record of all receipts, disbursements, and transactions made on behalf of the principal;

  (5) cooperate with any person that has authority to make health-care decisions for the principal to do what you know the principal reasonably expects or, if you do not know the principal’s expectations, to act in the principal’s best interests; and

  (6) attempt to preserve the principal’s estate plan if you know the plan and preserving the plan is consistent with the principal’s best interests.

  Termination of Agent’s Authority

  You must stop acting on behalf of the principal if you learn of any event that terminates this power of attorney or your authority under this power of attorney. Events that terminate a power of attorney or your authority to act under a power of attorney include:

  (1) death of the principal;

  (2) the principal’s revocation of the power of attorney or your authority;

  (3) the occurrence of a termination event stated in the power of attorney;

  (4) the purpose of the power of attorney is fully accomplished; or

  (5) if you are married to the principal, a legal action is filed with a court to end your marriage, or for your legal separation, unless the Special Instructions in this power of attorney state that such an action will not terminate your authority.

  Liability of Agent

  The meaning of the authority granted to you is defined in the Vermont Uniform Power of Attorney Act, 14 V.S.A. chapter 127. If you violate the Vermont Uniform Power of Attorney Act, or act outside the authority granted, you may be liable for any damages caused by your violation. In addition to civil liability, failure to comply with your duties and authority granted under this document could subject you to criminal prosecution.

  If there is anything about this document or your duties that you do not understand, you should seek legal advice. (Added 2023, No. 60, § 1, eff. July 1, 2023; amended 2023, No. 161 (Adj. Sess.), § 16, eff. June 6, 2024.)