{"data":{"id":"us-vt/14-v.s.a.-4051","jurisdiction":"us-vt","citation":"14 V.S.A. § 4051","heading":"Statutory form power of attorney","body":"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.\nVERMONT STATUTORY FORM POWER OF ATTORNEY IMPORTANT INFORMATION\nThis 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.\nThis power of attorney does not authorize the agent to make health-care decisions for you.\nYou 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.\nThis 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.\nThis 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.\nIf 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.\nThis power of attorney becomes effective immediately unless you state otherwise in the Special Instructions.\nIf 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.\nDESIGNATION OF AGENT\nI _______________________________________ (Name of Principal) ( ) revoke all previous powers of attorney and name the following person as my agent:\nName of Agent: _______________________________________\nAgent’s Address: _______________________________________________________________________\nAgent’s Telephone Number: _______________________________________\nDESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)\nIf my agent is unable or unwilling to act for me, I name as my successor agent:\nName of Successor Agent: _______________________________________\nSuccessor Agent’s Address: _______________________________________________________________________\nSuccessor Agent’s Telephone Number: _______________________________________\nIf my agent is unable or unwilling to act for me, I name as my second successor agent:\nName of Second Successor Agent: _______________________________________\nSecond Successor Agent’s Address: _______________________________________________________________________\nSecond Successor Agent’s Telephone Number: _______________________________________\nGRANT OF GENERAL AUTHORITY\nI 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.\n(STRIKE THROUGH each subject you DO NOT want to include in the agent’s general authority.)\nReal Property\nTangible Personal Property\nStocks and Bonds\nCommodities and Options\nBanks and Other Financial Institutions\nOperation of Entity or Business\nInsurance and Annuities\nEstates, Trusts, and Other Beneficial Interests\nClaims and Litigation\nPersonal and Family Maintenance\nBenefits from Governmental Programs or Civil or Military Service\nRetirement Plans\nTaxes\nGRANT OF SPECIFIC AUTHORITY (OPTIONAL)\nMy agent MAY NOT do any of the following specific acts for me UNLESS I have INITIALED the specific authority listed below:\n(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.)\n( ) 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\n( ) Create, amend, revoke, or terminate an inter vivos, family, living, irrevocable, or revocable trust\n( ) Consent to the modification or termination of a noncharitable irrevocable trust under 14A V.S.A. § 411\n( ) Make a gift, subject to the limitations of 14 V.S.A. § 4047 (gifts) and any special instructions in this power of attorney\n( ) Create, amend, or change rights of survivorship\n( ) Create, amend, or change a beneficiary designation\n( ) Waive the principal’s right to be a beneficiary of a joint and survivor annuity, including a survivor benefit under a retirement plan\n( ) Exercise fiduciary powers that the principal has authority to delegate\n( ) Authorize another person to exercise the authority granted under this power of attorney\n( ) Disclaim or refuse an interest in property, including a power of appointment\n( ) Exercise authority with respect to elective share under 14 V.S.A. § 319\n( ) Exercise waiver rights under 14 V.S.A. § 323\n( ) 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)\n( ) Exercise authority with respect to intellectual property, including, without limitation, copyrights, contracts for payment of royalties, and trademarks\n( ) 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.\nLIMITATION ON AGENT’S AUTHORITY\nAn 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.\nWHEN POWER OF ATTORNEY EFFECTIVE\nThis power of attorney becomes effective when executed unless the principal has initialed one of the following:\n( ) This power of attorney is effective only upon my later incapacity. OR\n( ) This power of attorney is effective only upon my later incapacity or unavailability. OR\n( ) I direct that this power of attorney shall become effective when one or more of the following occurs:\n_________________________________________\n_________________________________________\n_________________________________________\n_________________________________________\n_________________________________________\n_________________________________________\n_________________________________________\nEFFECTIVE DATE\nThis 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.\nSPECIAL INSTRUCTIONS (OPTIONAL)\nYou may give special instructions on the following lines:\n_________________________________________\n_________________________________________\n_________________________________________\n_________________________________________\n_________________________________________\n_________________________________________\n_________________________________________\nNOMINATION OF GUARDIAN (OPTIONAL)\nIf 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:\nName of Nominee for [conservator or guardian] of my estate: _________________________________________\nNominee’s Address: _________________________________________\nNominee’s Telephone Number: _________________________________________\nName of Nominee for guardian of my person: _________________________________________\nNominee’s Address: _________________________________________\nNominee’s Telephone Number: _________________________________________\nRELIANCE ON THIS POWER OF ATTORNEY\nAny 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.\nSIGNATURE AND ACKNOWLEDGMENT\nYour Name Printed: _________________________________________\nYour Address: _________________________________________\nYour Telephone Number: _________________________________________\nState of: _________________________________________\nCounty of: _________________________________________\nThis document was acknowledged before me on: (Date)_________________________________________\nby . (Name of Principal)_________________________________________\n(Seal, if any): _________________________________________\nSignature of Notary: _________________________________________\nMy commission expires: _________________________________________\nIMPORTANT INFORMATION FOR AGENT\nAgent’s Duties\nWhen 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:\n(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;\n(2) act in good faith;\n(3) do nothing beyond the authority granted in this power of attorney; and\n(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.\nUnless the Special Instructions in this power of attorney state otherwise, you must also:\n(1) act loyally for the principal’s benefit;\n(2) avoid conflicts that would impair your ability to act in the principal’s best interest;\n(3) act with care, competence, and diligence;\n(4) keep a record of all receipts, disbursements, and transactions made on behalf of the principal;\n(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\n(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.\nTermination of Agent’s Authority\nYou 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:\n(1) death of the principal;\n(2) the principal’s revocation of the power of attorney or your authority;\n(3) the occurrence of a termination event stated in the power of attorney;\n(4) the purpose of the power of attorney is fully accomplished; or\n(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.\nLiability of Agent\nThe 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.\nIf there is anything about this document or your duties that you do not understand, you should seek legal advice.","path":["Title 14: Decedents Estates and Fiduciary Relations","Chapter 127: Vermont Uniform Power of Attorney Act","Subchapter 003: STATUTORY FORMS"],"source_url":"https://legislature.vermont.gov/statutes/section/14/127/04051","current_through":"2025 session","vintage":"","retrieved_at":"2026-09-05T17:16:59Z","sha256":"36a6f958318c127fa3ac9bc7d3f0c157358158f02bb339df30a4db091fba0339","source_id":"us-vt","stale":false,"prev":"us-vt/14-v.s.a.-4047","next":"us-vt/14-v.s.a.-4052"},"notice":"GroundRules: Original legal text. Not legal advice."}