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Find more court forms on the Vermont Judiciary website.

The PDF forms that we host on the VTLawHelp.org website are being made more accessible to users living with a disability. If a PDF is not fully accessible, the first sentence of that PDF will let you know where you can find a more accessible version of that document. This work is in progress. If we link to a PDF on another website, we cannot guarantee that it is an accessible document.

Forms

Advance Directive Forms

Adding an Advance Directive to the Registry
Send this form and your Advance Directive to the Vermont Advance Directive Registry to store it electronically so hospitals or other providers have quick access to it in an emergency.
Advance Directive for Health Care - Long Form
Use this form to create an Advance Directive for your health care. It is 11 pages long. Use this text or the PDF form below the text.  
Advance Directive for Health Care - Short Form
Use this form to create an Advance Directive for your health care. It is three pages long.

Complaint Forms

Complaint About Discrimination in School
Use this form to file a complaint with the Vermont Human Rights Commission if you or your child has experienced discrimination at your child's school.
Consumer Complaint
Use this form to file a consumer complaint in Vermont, for example if a debt collector does something they're not supposed to.
Employment Discrimination Complaint Form
Fill out this form if you have been discriminated against at work in Vermont.  
Employment Discrimination Form for State of Vermont Employees
If you are an applicant or employee at the State of Vermont, use this employment discrimination form.
Federal Trade Commission Complaint Form
Use this form to file a complaint with the FTC.  
Health Information Privacy Complaint Form
If you think your health information privacy rights have been violated, you can file a complaint with the U.S. Department of Health and Human Services.
Health Information Privacy Complaint Involving AHS Form
If you believe that your health information privacy rights have been violated by the Vermont Agency of Human Services, you can file a complaint.
Housing Discrimination Complaint Form for Vermont Human Rights Commission
To file a housing discrimination complaint with the Vermont Human Rights Commission, fill in this form.
HUD Federal Housing Law Discrimination Complaint
HUD (the U.S. Department of Housing and Urban Development) handles violations of federal housing law, including discrimination violations.
Insurance Complaint Form
Use this form to file a complaint about your insurance company with the Department of Financial Regulation.
Office of Professional Regulation Complaint Form
If you have a complaint about a medical provider other than a doctor, physician's assistant or podiatrist, use this form.
Vermont Board of Medical Practice Complaint Form
Use this form to file a complaint about a doctor, physician's assistant or podiatrist.
Wage Claim Form
If you have a wage or pay problem with your employer, use this Vermont Department of Labor (DOL) form to ask for help.

CourtFormPrep

Ask the Court to Order Financial Disclosure
Use this CourtFormPrep form to file a request for the court to order the other party in a small claims case to give you and the court more information about their financial situation.
Fill Out Financial Disclosure Paperwork
Use this CourtFormPrep form to fill out Small Claims Financial Disclosure paperwork to tell the court about your financial situation.  
Form 813A - Financial Affidavit
Use this income and expense affidavit when filing for divorce in the state of Vermont. 
Form 813B - Financial Affidavit
Use this property and asset affidavit when filing for divorce in the state of Vermont.  
Inventory for an Estate in Probate
This CourtFormPrep program will help you fill out the paperwork you need to fill out an inventory for an estate in probate court.  
Open an Estate in Probate
This CourtFormPrep program will help you fill out the paperwork you need to open an estate in probate court.  
Prepare a Motion to Enforce Child Support
Use this CourtFormPrep program to prepare a motion to enforce your child support order in the state of Vermont.  
Prepare a Motion to Modify Child Support
Use this CourtFormPrep program to prepare a motion to modify (change) your child support order in the state of Vermont.  
Responding to a Divorce, Civil Union Dissolution or Legal Separation
Use this CourtFormPrep form to respond to a divorce, civil union dissolution or legal separation complaint from your partner.  
Start a Divorce, Civil Union Dissolution or Legal Separation
Use this CourtFormPrep form to start a divorce, civil union dissolution or legal separation in the state of Vermont.  
Start a Small Claims Case
Use this CourtFormPrep form to file a Small Claims Complaint in Vermont.  

Debt Collection Forms

Consumer Complaint
Use this form to file a consumer complaint in Vermont, for example if a debt collector does something they're not supposed to.
Don’t Call Me at Work Form Letter
Use this form letter to tell debt collectors to stop calling you at work.
Stop Debt Collection Calls and Exempt Income letter
Use this form letter to tell debt collectors to stop calling you. 

Disaster Forms

Application for Small Business Association Disaster Loan
The SBA provides low interest disaster loans. Businesses can apply if they suffered physical property damage or economic injury, even if not located in the disaster area.
IRS Form 1040X: Amended US Individual Income Tax Return
Use this form to amend last year's return. For example, use this form if you are claiming a loss for the previous year due to a natural disaster.  
IRS Form 4506-T: Request for Transcript of Tax Return
To request an IRS account transcript (computer printout), use this form. You can also use the short form, 4506T-EZ.
IRS Form 4506: Request for Copy of Tax Return
To request copies of tax returns, complete this form. Copies of past tax returns are free for people affected by a federally declared disaster area.
IRS Form 4506T-EZ: Request for Individual Tax Return Transcript
This is the short form version of Form 4506-T. Use this form to ask for a free tax transcript. It can be used in the foreclosure mediation process.
IRS Form 4684: Casualties and Thefts
To calculate and report casualty losses, such as after a natural disaster, you will need to complete this form.  
IRS Form 8822: Change of Address
If you have a new address, complete this form to notify the IRS. Updating your address with the post office does not update it with the IRS.

Family Forms

Apply for Public Benefits
Use this link to apply for these Vermont programs: 3SquaresVT, Fuel Assistance, Reach Up and Essential Person.
Complaint About Discrimination in School
Use this form to file a complaint with the Vermont Human Rights Commission if you or your child has experienced discrimination at your child's school.
Complaint for Legal Separation - No Kids
Use this form to file for legal separation in Vermont if you and your spouse do not have children.  
Complaint for Legal Separation - With Kids
Use this form to file for legal separation if you and your spouse have children.  
Department of Health Civil Union Dissolution Form
Use this form to order a civil union dissolution certificate from the Department of Health.  
Department of Health Record of Divorce
Use this form when you are going through a divorce in the state of Vermont. 
Divorce Answer and Counterclaim - No Kids
Use this form if you are the defendant in a divorce case in Vermont and don't have children.
Divorce Answer and Counterclaim - With Kids
Use this form if you are the defendant in a divorce case in Vermont and have children.
Form 813A - Financial Affidavit
Use this income and expense affidavit when filing for divorce in the state of Vermont. 
Form 813B - Financial Affidavit
Use this property and asset affidavit when filing for divorce in the state of Vermont.  
HUD Federal Housing Law Discrimination Complaint
HUD (the U.S. Department of Housing and Urban Development) handles violations of federal housing law, including discrimination violations.
IFP Form to Reduce or Waive the Court Filing Fee
If you cannot afford the court filing fee, bring this form with you to the courthouse. The clerk may be able to waive the fee for you so you don't have to pay.
Initiate Motion to Modify Child Custody Order
Use this form to initiate a Motion to Modify to change your child custody order.  
Inventory for an Estate in Probate
This CourtFormPrep program will help you fill out the paperwork you need to fill out an inventory for an estate in probate court.  
Notice Against Trespass
If you ask someone to stop coming into your home but the person keeps coming anyway, you can use a Notice Against Trespass to keep the person out.
Notice of Appearance - Divorce
If you are the defendant in a divorce case and have no children, file either a Notice of Appearance or Answer and Counterclaim within 21 days of being served with the court papers.
Open an Estate in Probate
This CourtFormPrep program will help you fill out the paperwork you need to open an estate in probate court.  
Prepare a Motion to Enforce Child Support
Use this CourtFormPrep program to prepare a motion to enforce your child support order in the state of Vermont.  
Prepare a Motion to Modify Child Support
Use this CourtFormPrep program to prepare a motion to modify (change) your child support order in the state of Vermont.  
Property Stipulation Form
Use this form when you are filing for non-resident divorce or dissolution of a civil union. 
Relief from Abuse Affidavit
An affidavit is a sworn statement. The Relief from Abuse Affidavit is filed with your request for a Relief from Abuse Order.
Relief from Abuse Affidavit on Behalf of a Child
This form is used to give a sworn statement about what happened to cause you to file a Relief from Abuse Complaint on behalf of a child.
Relief from Abuse Complaint
A Relief from Abuse Order is a court order that tells your abuser they can't abuse you anymore. To get one, file this form and a Relief from Abuse Affidavit.
Relief from Abuse Complaint on Behalf of a Child
This form is used to ask for a Relief from Abuse Order on behalf of a minor child. This form must be filed with the Relief From Abuse Affidavit on Behalf of a Child.
Responding to a Divorce, Civil Union Dissolution or Legal Separation
Use this CourtFormPrep form to respond to a divorce, civil union dissolution or legal separation complaint from your partner.  
Start a Divorce, Civil Union Dissolution or Legal Separation
Use this CourtFormPrep form to start a divorce, civil union dissolution or legal separation in the state of Vermont.  

Foreclosure Forms

Foreclosure Answer Form
Complete this form if you receive a foreclosure Complaint. You must file a written Answer within 21 calendar days of when you received the Complaint.  
Foreclosure Notice of Appearance
If you are a tenant and your landlord is being foreclosed on, use this form to enter an appearance in the foreclosure case and to get notices about the foreclosure case.  
IFP Form to Reduce or Waive the Court Filing Fee
If you cannot afford the court filing fee, bring this form with you to the courthouse. The clerk may be able to waive the fee for you so you don't have to pay.
IRS Form 4506T-EZ: Request for Individual Tax Return Transcript
This is the short form version of Form 4506-T. Use this form to ask for a free tax transcript. It can be used in the foreclosure mediation process.

Medicaid Forms

Medicaid 205ALLMED Application
To apply for Medicaid for the Aged, Blind and Disabled & Medicaid for the Working Disabled (MABD).
Vermont Medicaid Coverage Exception Request
If Vermont Medicaid tells you that it does not cover a service you need, you can ask for Medicaid to make an exception and cover the service.
Vermont Pharmacy Programs Application (VPharm)
If you only need to apply for prescription help in Vermont, use the 201P application.

Medicare Forms

Medicare Authorization to Disclose Personal Health Information Form
Use this form to allow Medicare to give your personal health information to someone other than you.  
Medicare Savings Programs
To apply for Medicare Savings Programs.
Vermont Pharmacy Programs Application (VPharm)
If you only need to apply for prescription help in Vermont, use the 201P application.

Power of Attorney Forms

Form to Revoke Power of Attorney
Use this form to revoke (remove) Power of Attorney from your agent.
General Power of Attorney for Financial Affairs Form
Use this form to give someone Power of Attorney for your financial affairs. This means that this person is allowed to help you manage your money and property.

Prescription Drug Forms

Vermont Pharmacy Programs Application (VPharm)
If you only need to apply for prescription help in Vermont, use the 201P application.

Public Benefits Forms

Application for Energy Assistance from Green Mountain Power
Use this form to apply to the Green Mountain Power Energy Assistance Program for help providing electricity to your home.  
Application for Energy Assistance from Vermont Gas Systems
Use this form to apply to the Vermont Gas Energy Assistance Program for help providing gas to your home.  
Apply for Public Benefits
Use this link to apply for these Vermont programs: 3SquaresVT, Fuel Assistance, Reach Up and Essential Person.
Developmental Disability Services Request for a Fair Hearing
You can request a fair hearing if your request was denied or approved at less than you asked for, or if your amount goes down or stops.  
Food Stamp Medical Expense Worksheet
Do you have medical expenses? Do you have a disability or are you over 60? Should you get more food stamps?  
Form to Appeal Public Benefits Decision
You have the right to appeal decisions from the Department for Children and Families (DCF) about your benefits.  Use this form to appeal.
Housing Appeal Letter
Use this form letter to ask for a hearing if someone refuses to give you rent assistance or if your rent assistance or Section 8 is being stopped.
IFP Form to Reduce or Waive the Court Filing Fee
If you cannot afford the court filing fee, bring this form with you to the courthouse. The clerk may be able to waive the fee for you so you don't have to pay.
Preliminary Application for Housing/Rental Assistance in Burlington
Use this form to apply for housing/rental assistance in Burlington.  
Reach Up Grant Decrease Appeal Form Letter
If your Reach Up grant recently went down (decreased), you can appeal with this Form Letter.  
Vermont Fuel Assistance Application
To find out if you’re eligible for Fuel Assistance to help pay for your home heating bills, fill out this application.
Vermont Pharmacy Programs Application (VPharm)
If you only need to apply for prescription help in Vermont, use the 201P application.
You First Health Program Application
You First is a health program for Vermont women with a low income.

Relief from Abuse

Relief from Abuse Affidavit
An affidavit is a sworn statement. The Relief from Abuse Affidavit is filed with your request for a Relief from Abuse Order.
Relief from Abuse Affidavit on Behalf of a Child
This form is used to give a sworn statement about what happened to cause you to file a Relief from Abuse Complaint on behalf of a child.
Relief from Abuse Complaint
A Relief from Abuse Order is a court order that tells your abuser they can't abuse you anymore. To get one, file this form and a Relief from Abuse Affidavit.
Relief from Abuse Complaint on Behalf of a Child
This form is used to ask for a Relief from Abuse Order on behalf of a minor child. This form must be filed with the Relief From Abuse Affidavit on Behalf of a Child.

Renter (Tenant) / Landlord

Application for Energy Assistance from Green Mountain Power
Use this form to apply to the Green Mountain Power Energy Assistance Program for help providing electricity to your home.  
Application for Energy Assistance from Vermont Gas Systems
Use this form to apply to the Vermont Gas Energy Assistance Program for help providing gas to your home.  
Apply for Public Benefits
Use this link to apply for these Vermont programs: 3SquaresVT, Fuel Assistance, Reach Up and Essential Person.
Disability - Request for Reasonable Accommodations or Modifications in Your Housing
When a person’s disabilities prevent them from using or enjoying their housing in the same way as people without disabilities, they can ask for reasonable changes in their housing.
Eviction Answer Form
Use this Answer form when the landlord is trying to evict you.
Eviction Counterclaim Form
Use this counterclaim form during the eviction process.
Foreclosure Notice of Appearance
If you are a tenant and your landlord is being foreclosed on, use this form to enter an appearance in the foreclosure case and to get notices about the foreclosure case.  
Housing Appeal Letter
Use this form letter to ask for a hearing if someone refuses to give you rent assistance or if your rent assistance or Section 8 is being stopped.
Housing Discrimination Complaint Form for Vermont Human Rights Commission
To file a housing discrimination complaint with the Vermont Human Rights Commission, fill in this form.
HUD Federal Housing Law Discrimination Complaint
HUD (the U.S. Department of Housing and Urban Development) handles violations of federal housing law, including discrimination violations.
IFP Form to Reduce or Waive the Court Filing Fee
If you cannot afford the court filing fee, bring this form with you to the courthouse. The clerk may be able to waive the fee for you so you don't have to pay.
Letter to Landlord about Access
Use this letter to let your landlord know about the law about coming into your apartment.
Notice Against Trespass
If you ask someone to stop coming into your home but the person keeps coming anyway, you can use a Notice Against Trespass to keep the person out.
Preliminary Application for Housing/Rental Assistance in Burlington
Use this form to apply for housing/rental assistance in Burlington.  
Repair Letter to Landlord
Use this form letter to tell your landlord about repairs needed at your home.
Security Deposit Return Letter
Use this form letter to ask your landlord to return your security deposit. Use the text or the PDF below.  
Vermont Fuel Assistance Application
To find out if you’re eligible for Fuel Assistance to help pay for your home heating bills, fill out this application.
VT Landlord's Certificate: Form LC-142
Your landlord has to give you this form by 1/31 (if your apartment/house has more than one rented unit) or a reasonable amount of time after you ask for it (if there's only one unit).
VT Renter Rebate Claim and Household Income: Forms PR-141 and HI-144
Use these forms from the Vermont Department of Taxes to claim the renter rebate.  

Small Claims Forms

Ask the Court to Order Financial Disclosure
Use this CourtFormPrep form to file a request for the court to order the other party in a small claims case to give you and the court more information about their financial situation.
Fill Out Financial Disclosure Paperwork
Use this CourtFormPrep form to fill out Small Claims Financial Disclosure paperwork to tell the court about your financial situation.  
IFP Form to Reduce or Waive the Court Filing Fee
If you cannot afford the court filing fee, bring this form with you to the courthouse. The clerk may be able to waive the fee for you so you don't have to pay.
Notice of Appearance
Use this form to give the court your contact information. Send them a new form if something changes. The court can then send you copies of any notices, court dates and paperwork filed in court.
Respond to a Small Claims Complaint
Use this form to respond to (answer) a small claims complaint that someone filed against you.  
Small Claims Financial Disclosure Statement Form
This form is for disclosing (telling the court about) your finances in a small claims case.  
Start a Small Claims Case
Use this CourtFormPrep form to file a Small Claims Complaint in Vermont.  

Tax Forms

IRS Form 1040X: Amended US Individual Income Tax Return
Use this form to amend last year's return. For example, use this form if you are claiming a loss for the previous year due to a natural disaster.  
IRS Form 4506-T: Request for Transcript of Tax Return
To request an IRS account transcript (computer printout), use this form. You can also use the short form, 4506T-EZ.
IRS Form 4506: Request for Copy of Tax Return
To request copies of tax returns, complete this form. Copies of past tax returns are free for people affected by a federally declared disaster area.
IRS Form 4506T-EZ: Request for Individual Tax Return Transcript
This is the short form version of Form 4506-T. Use this form to ask for a free tax transcript. It can be used in the foreclosure mediation process.
IRS Form 8822: Change of Address
If you have a new address, complete this form to notify the IRS. Updating your address with the post office does not update it with the IRS.
IRS Free File Fillable Forms
Instructions and online forms to file your federal income tax return for free.  
IRS Tax Forms
Links to all IRS tax forms and their instructions.
VT Homestead Declaration and Property Tax Adjustment Claim: Forms HS-122 and HI-144
This set of forms is used to tell the state of Vermont that you live in the house you own (homestead declaration) and to ask for help paying your property taxes (property tax adjustment claim).
VT Landlord's Certificate: Form LC-142
Your landlord has to give you this form by 1/31 (if your apartment/house has more than one rented unit) or a reasonable amount of time after you ask for it (if there's only one unit).
VT Renter Rebate Claim and Household Income: Forms PR-141 and HI-144
Use these forms from the Vermont Department of Taxes to claim the renter rebate.  
VT Tax Forms
Links to all Vermont tax forms and their instructions.
Updated: Aug 14, 2019