§ 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
( ) Create, amend, or change rights of survivorship
( ) 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; 2025, No. 64, § 14, eff. June 12, 2025.)