Forms

Advance Directive Forms

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.
Use this form to create an Advance Directive for your health care. It is 11 pages long. Use this text or the fillable PDF form below the text.  
Use this form to create an Advance Directive for your health care. It is three pages long. Use this text or the fillable PDF form below the text.

Complaint Forms

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.
Use this form to file a consumer complaint in Vermont, for example if a debt collector does something they're not supposed to.
Fill out this form if you have been discriminated against at work in Vermont.  
If you are an applicant or employee at the State of Vermont, use this employment discrimination form.
Use this form to file a complaint with the FTC.  
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.
If you believe that your health information privacy rights have been violated by the Vermont Agency of Human Services, you can file a complaint.
To file a housing discrimination complaint with the Vermont Human Rights Commission, fill in this form.
HUD (the U.S. Department of Housing and Urban Development) handles violations of federal housing law, including discrimination violations.
Use this form to file a complaint about your insurance company with the Department of Financial Regulation.
If you have a complaint about a medical provider other than a doctor, physician's assistant or podiatrist, use this form.
Use this form to file a complaint about a doctor, physician's assistant or podiatrist.
If you have a wage or pay problem with your employer, use this Vermont Department of Labor (DOL) form to ask for help.

Debt Collection Forms

If you cannot afford a court filing fee, use this form. The clerk may be able to waive the fee for you so you don’t have to pay.
This form is filed with the court to confirm that you sent court documents to the other party in a case. Be sure to find out what kind of service is required for your kind of court case.
Use this form to file a consumer complaint in Vermont, for example if a debt collector does something they're not supposed to.
Use this form letter to tell debt collectors to stop calling you. 

Disaster Forms

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.  
To request an IRS account transcript (computer printout), use this form. You can also use the short form, 4506T-EZ.
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.
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.
To calculate and report casualty losses, such as after a natural disaster, you will need to complete this form.  
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

If you cannot afford a court filing fee, use this form. The clerk may be able to waive the fee for you so you don’t have to pay.
Use this link to apply for these Vermont programs: 3SquaresVT, Fuel Assistance, Reach Up and Essential Person.
This form is filed with the court to confirm that you sent court documents to the other party in a case. Be sure to find out what kind of service is required for your kind of court case.
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.
Use this form to order a civil union dissolution certificate from the Vermont Department of Health.
Use this form when you are going through a divorce in the state of Vermont.  
Use this income and expense affidavit when filing for divorce in the state of Vermont.  
Use this property and asset affidavit when filing for divorce in the state of Vermont.  
Fill out an inventory for an estate in probate court.  
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.
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.
Fill out the paperwork you need to open an estate in probate court, when someone has died.
Use the Summons and Complaint form if you want to start a parentage action. If you receive a Summons and Complaint, you need to send in the Answer within 21 days.
Prepare a motion to enforce your child support order in the state of Vermont.  
Ask the court to change your child custody or visitation order.
Ask the court to modify (change) your child support order in the state of Vermont.  
Learn how to get a Relief from Abuse (RFA) order and get the forms to use in our RFA Roadmap.
Respond to a divorce, civil union dissolution or legal separation Complaint from your partner by using an Answer form.
Get the forms you need to start a divorce, civil union dissolution or legal separation in Vermont.

Foreclosure Forms

If you cannot afford a court filing fee, use this form. The clerk may be able to waive the fee for you so you don’t have to pay.
This form is filed with the court to confirm that you sent court documents to the other party in a case. Be sure to find out what kind of service is required for your kind of court case.
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.
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.
Before you can get mortgage assistance payments through the Vermont COVID Emergency Mortgage Assistance Program, VHFA will need to talk to your mortgage servicer about your mortgage debt. Use this sample letter.

Medicaid Forms

To apply for Medicaid for the Aged, Blind and Disabled (MABD) & Medicaid for the Working Disabled.
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.
If you only need to apply for prescription help in Vermont, use the 201P application.

Medicare Forms

Use this form to allow Medicare to give your personal health information to someone other than you.  
To apply for Medicare Savings Programs.
If you only need to apply for prescription help in Vermont, use the 201P application.

Power of Attorney Forms

Use this form to revoke (remove) Power of Attorney from your agent.
A Power of Attorney is a legal document to give another person authority to handle your financial and personal decisions.

Prescription Drug Forms

If you only need to apply for prescription help in Vermont, use the 201P application.

Probate Court Forms

This form is filed with the court to confirm that you sent court documents to the other party in a case. Be sure to find out what kind of service is required for your kind of court case.
Fill out an inventory for an estate in probate court.  
Change your name in Vermont.
Fill out the paperwork you need to open an estate in probate court, when someone has died.

Public Benefits Forms

Apply to the Green Mountain Power Energy Assistance Program for help providing electricity to your home.  
Apply to the Vermont Gas Energy Assistance Program for help providing gas to your home.  
If you cannot afford a court filing fee, use this form. The clerk may be able to waive the fee for you so you don’t have to pay.
Use this link to apply for these Vermont programs: 3SquaresVT, Fuel Assistance, Reach Up and Essential Person.
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.  
You have the right to appeal decisions from the Department for Children and Families (DCF) about your benefits.  Use this form to appeal.
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.
Use this form to apply for housing/rental assistance in Burlington.  
If your Reach Up grant recently went down (decreased), you can appeal with this Form Letter.  
To find out if you’re eligible for Fuel Assistance to help pay for your home heating bills, fill out this application.
If you only need to apply for prescription help in Vermont, use the 201P application.
You First is a health program for Vermont women with a low income.

Relief from Abuse

Learn how to get a Relief from Abuse (RFA) order and get the forms to use in our RFA Roadmap.

Renter (Tenant) / Landlord

Apply to the Green Mountain Power Energy Assistance Program for help providing electricity to your home.  
Apply to the Vermont Gas Energy Assistance Program for help providing gas to your home.  
If you cannot afford a court filing fee, use this form. The clerk may be able to waive the fee for you so you don’t have to pay.
Use this link to apply for these Vermont programs: 3SquaresVT, Fuel Assistance, Reach Up and Essential Person.
This form is filed with the court to confirm that you sent court documents to the other party in a case. Be sure to find out what kind of service is required for your kind of court case.
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.
Use this Answer form when the landlord is trying to evict you. Generally, a tenant/defendant must file an Answer 21 days after the day the Complaint was served.
Use this counterclaims form during the eviction process, if needed.
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.
To file a housing discrimination complaint with the Vermont Human Rights Commission, fill in this form.
HUD (the U.S. Department of Housing and Urban Development) handles violations of federal housing law, including discrimination violations.
Use this letter to let your landlord know about the law about coming into your apartment.
In most kinds of subsidized housing, you can ask for your rent to be recalculated if your income drops. We have created a form letter that you can use.
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.
Use this form to apply for housing/rental assistance in Burlington.  
Use this form letter to tell your landlord about repairs needed at your home.
Use this letter to tell your landlord you have defects in your rental unit that materially affect health and safety. 
Use this form letter to ask your landlord to return your security deposit.
To find out if you’re eligible for Fuel Assistance to help pay for your home heating bills, fill out this application.
Use form RCC-146 from the Vermont Department of Taxes to claim the renter credit, formerly called the renter rebate.

Small Claims Forms

If you cannot afford a court filing fee, use this form. The clerk may be able to waive the fee for you so you don’t have to pay.
In a small claims case, use this form to ask the court to order the other party to give you and the court more information about their financial situation.
This form is filed with the court to confirm that you sent court documents to the other party in a case. Be sure to find out what kind of service is required for your kind of court case.
Use this form to fill out Small Claims Financial Disclosure paperwork to tell the court about your financial situation.  
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.
Use this form to respond to (answer) a small claims complaint that someone filed against you.  
File a Small Claims Complaint in Vermont.  

Tax Forms

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.  
To request an IRS account transcript (computer printout), use this form. You can also use the short form, 4506T-EZ.
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.
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.
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.
Instructions and online forms to file your federal income tax return for free.  
Links to all IRS tax forms and their instructions.
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 credit claim).
Links to all income tax forms for individuals and their instructions.  
Use form RCC-146 from the Vermont Department of Taxes to claim the renter credit, formerly called the renter rebate.
Updated: Dec 11, 2023