Use this form to create a Power of Attorney (POA). It is a legal document that allows you to give another person the authority to handle your financial and personal decisions. The form includes instructions, as well as an optional Addendum at the end.

Use this text or the fillable PDF form below the text.

Learn more on our Financial Power of Attorney page.

VERMONT DURABLE POWER OF ATTORNEY FORM

This Power of Attorney form authorizes another person (your Agent) to make financial decisions for you (the Principal). Your Agent will be able to make financial decisions for you and your property (including your money), even if you can act for yourself. Your agent should take your direction. You should select someone you trust as your Agent. This Power of Attorney does NOT authorize your Agent to make healthcare decisions.

You must initial the paragraph below that all previous Powers of Attorney are revoked. Otherwise, previous Powers of Attorney remain in effect. Vermont Legal Aid does not recommend having more than one Power of Attorney document in effect because of the potential for conflict.

My Name:  [Enter name]

My Address:  [Enter address]

My Phone:  [Enter phone]

1. DESIGNATION OF AGENT

I appoint the following person as my agent:

Name of Agent:  [Enter name]

Agent’s Address:  [Enter address]

Telephone:  [Enter phone]

____[Initial here to choose this]  I revoke all previous general powers of attorney.

1. DESIGNATION OF CO-AGENT (OPTIONAL)

If you wish to have more than one Agent, you may designate a co-agent. Vermont Legal Aid does not recommend appointing independent co-agents because of the potential for conflict. The co-agent’s authority begins at the same time as the Agent’s. Unless you indicate otherwise, co-agents have independent authority and are not required to act together. If you wish to have the Agent and co-agent act together, you should initial below.

Name of Co-Agent:  [Enter name]

Co-Agent’s Address:  [Enter address]

Telephone:  [Enter phone]

____[Initial here to choose this]  I want my co-agents to agree before acting. If there is a dispute between the co-agents, the first designated Agent (Section 1) shall make the decision.

2. DESIGNATION OF REPLACEMENT AGENT(S) (RECOMMENDED)

You can pick someone to serve as your successor Agent, or replacement Agent. Designation of a replacement Agent is recommended but not required. A replacement Agent may only act if the original Agent(s) is unable or unwilling to do so. A replacement Agent has the same authority as the original Agent.

If my Agent resigns, dies, becomes incapacitated or unavailable, is not qualified to serve or declines to serve, I name as my replacement (successor) Agent:

Name of Replacement Agent:  [Enter name]

Replacement Agent’s Address:  [Enter address]

Telephone:  [Enter phone]

If my replacement resigns, dies, becomes incapacitated or unavailable, is not qualified to serve or declines to serve, I name as my second replacement Agent:

Name of 2nd Replacement Agent:  [Enter name]

2nd Replacement Agent’s Address:  [Enter address]

Telephone:  [Enter phone]

2. WHEN THIS POWER OF ATTORNEY STARTS

Choose when the Power of Attorney becomes effective. If you wish to have the Power of Attorney begin later, or when a certain event occurs, you must initial and specify the event below. You must pick only one option.

____[Initial here to choose this]  I want this Power of Attorney to start now.

____[Initial here to choose this]  I want this Power of Attorney to start upon my later incapacity or unavailability.

____[Initial here to choose this]  I want this Power of Attorney to start when an event occurs.

If you would like this Power of Attorney to become effective when an event occurs, you should describe the event and choose a person to determine that this event has occurred.

Description of Event:  [Enter event]

Person to Decide:  [Enter name]

Relationship to Me:  [Enter relationship]

Contact Info:  [Enter contact info]

If you would like this Power of Attorney to become effective when you are incapacitated or unavailable, you can choose the person to decide that you lack capacity. This is optional. Your Agent should not be the person to decide when this Power of Attorney starts.

Person authorized to determine whether I am incapacitated or unavailable:

Person to Decide:  [Enter name]

Relationship to Me:  [Enter relationship]

Contact Info:  [Enter contact info]

3. NOMINATION OF GUARDIAN (OPTIONAL)

If a Court decides that I am in need of guardianship, I request that the Court follow my wishes set forth below.

If I need a Guardian in the future, I want this person to be my Guardian:

Name:  [Enter name]

Address:  [Enter address]

Phone:  [Enter phone]

I do NOT want the following person(s) to be my Guardian:

Name:  [Enter name]

Address:  [Enter address]

4. GRANT OF GENERAL AUTHORITY

ALL the subjects listed below are included in the agent’s general authority. If you wish to limit your Agent’s general authority, you should consult a qualified estate planning attorney before signing this Power of Attorney.

I give my Agent the full authority to handle my personal and financial affairs.  This includes but is not limited to managing all my financial matters, accessing all my information, accounts, real property, and tangible personal property; and performing any act relating to any matter, account, transaction, real property, or tangible personal property, now owned or later acquired by me, to the same extent that I have the right to manage, access or perform myself.

I grant my Agent authority over All Listed Subjects:

• Real Property (your home and land)
• Tangible Personal Property (your possessions)
• Stocks and Bonds
• Commodities and Options
• Banks and Other Financial Institutions (bank accounts)
• Operation of Entity or Business
• Insurance and Annuities
• Claims and Litigation
• Personal and Family Maintenance
• Retirement Plans
• Taxes
• Estates, Trusts, and Other Beneficial Interests
• Benefits from Governmental Programs, Civil or Military Service

5. DURABLE POWER OF ATTORNEY

This Power of attorney is “durable.” My Agent will still have the authority to make financial decisions for me, even if I am unavailable or lack capacity. I understand that I cannot revoke this Power of Attorney if I have been determined to lack capacity.

6. ACCOUNTINGS

1. My Agent must keep a written record of all transactions taken under this Power of Attorney and must provide me with a written statement of all such transactions upon request. Accountings shall include current copies of all financial statements, credit card statements and loan statements, in addition to all transaction history.
2. My Agent shall provide me with regular accountings every:

[Choose one]

[   ] One Month

[  ] Three Months

[   ] Six Months

3. My Agent shall provide a copy of the regular accountings to the following person or institution:

Name:  [Enter name]

Address:  [Enter address]

4. Upon my request, my Agent shall provide accountings to me, any State agency, Federal agency, or court within 30 days of any request. Failure to provide accountings shall be a breach of the Agent’s duty.

7. RELIANCE ON THIS POWER OF ATTORNEY

Any person (including my Agent) may rely upon the validity of this Power of Attorney, unless that person knows the Agent’s authority has terminated or is invalid. A copy of this document has the same effect as the original.

8. SPECIAL INSTRUCTIONS

You may use the space below to provide further instructions regarding any other section of this Power of Attorney.

[Type special instructions here]

____[Initial here to choose this]  I am including the Addendum with grant(s) of specific authority. 

9. COMPLIANCE WITH THE UNIFORM POWER OF ATTORNEY ACT

This form and the Addendum are intended to comply with the Uniform Power of Attorney Act, 14 V.S.A. §4001 et seq., as adopted by the Vermont Legislature as of June 2023. All terms should be interpreted as in compliance with the Uniform Power of Attorney Act.

SIGNATURE AND ACKNOWLEDGMENT

This Power of Attorney MUST be signed by you, or another person authorized to sign on your behalf. Your signature on this Power of Attorney document is presumed valid if you sign it in the presence of a notary public.

Your Signature:  [Sign here]
Date:  [Enter date]
Your Name (Printed): [Enter name]
Your Address:  [Enter address]
Your Telephone Number:  [Enter phone]
Notary Acknowledgement

State of Vermont, County of:  [Notary enters county]

On this date [Enter date] in [Enter town/city], Vermont.

[Notary enters your name], appeared before me, and is personally known to me or proved to me based on satisfactory evidence, and acknowledged that this Power of Attorney was executed as a voluntary act and deed for the purposes therein contained.

Signature of notary public:  [Notary signs here]
Title of office:  [Notary enters title]
My commission expires:  [Notary enters date]

OPTIONAL The signature of a witness is not required for this Power of Attorney to be effective, but it is recommended if the Power of Attorney is not notarized. A person appointed as an Agent should not be the witness.

I affirm that the Principal appeared to understand the nature of this Power of Attorney and appeared to be free from duress or undue influence at the time this was signed.
    
Witness Signature:  [Witness signs here]
Date:  [Witness enters date]
Witness Name (Printed):
Witness Address:

Agent’s Acceptance of Appointment

I accept the appointment as the Agent under the terms of this Power of Attorney.
    
Agent’s Signature:  [Agent signs here]
Date:  [Agent enters date]
Agent’s Name (Printed):  [Agent enters name]

Certification of Event/Incapacity/Unavailability (If Applicable)

I certify that 1) the triggering event has occurred, 2) the Principal lacks capacity, or 3) the Principal is unavailable, as specified above, and that this Power of Attorney is now in effect.
    
Signature:  [Authorized person signs here]
Date:  [Authorized person enters date]
Name (Printed):  [Authorized person enters name]

ADDENDUM TO POWER OF ATTORNEY (OPTIONAL)

Completion of this Addendum is optional. All sections of the Addendum comply with the Uniform Power of Attorney Act. You should speak with a qualified estate planning attorney before completing this Addendum.

10. GRANT OF SPECIFIC AUTHORITY

The Uniform Power of Attorney Act allows you to grant your Agent specific powers. Granting any the powers below could give your Agent authority to 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.

If you choose not to initial a specific authority listed below, your Agent will not have the power to perform that act. 

____[Initial here to choose this]  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.

____[Initial here to choose this]  Create, amend, revoke or terminate an inter vivos, family, living, irrevocable or revocable trust.  

____[Initial here to choose this]  Consent to the modification or termination of a noncharitable irrevocable trust under (even if the modification or termination is inconsistent with the material purpose of the trust). 14A V.S.A. § 411.

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

____[Initial here to choose this]  Create, amend or change rights of survivorship.

____[Initial here to choose this]  Create, amend or change a beneficiary designation.

____[Initial here to choose this]  Waive the principal’s right to be a beneficiary of a joint and survivor annuity, including a survivor benefit under a retirement plan. 

____[Initial here to choose this]  Exercise fiduciary powers that the principal has authority to delegate. 

____[Initial here to choose this]  Authorize another person to exercise the authority granted under this power of attorney.

____[Initial here to choose this]  Disclaim or refuse an interest in property, including a power of appointment.

____[Initial here to choose this]  Waive, on my behalf, the provisions of my deceased spouse’s will and take one-half the balance of the probate estate after the payment of allowances, claims, and expenses. 14 V.S.A. § 319.

____[Initial here to choose this]  Waive, on my behalf, my right to an elective share of my deceased spouse’s estate, to a homestead or other allowance, and waive any other spousal rights or interest in property.

____[Initial here to choose this]  Exercise authority over the content and catalogue of electronic communications and digital assets under 14 V.S.A. Chapter 125.

____[Initial here to choose this]  Exercise authority with respect to intellectual property, including, without limitation, copyrights, contracts for payment of royalties, and trademarks.
    
____[Initial here to choose this] Convey, or revoke or revise a grantee designation, by enhanced life estate deed pursuant to chapter 6 of Title 27 or under common law.

INCORPORATION OF ADDENDUM INTO POWER OF ATTORNEY

I want the specific powers and limitations selected in this addendum to be incorporated into my Power of Attorney.

Signature of Principal:  [Principal signs here]
Date:  [Principal enters date]

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 requires you to carry out legal duties until you resign, or the Power of Attorney is terminated or revoked. The Principal retains full decision-making authority, as long as they have the ability to make decisions. As the Agent, you must:

• Do what you know the Principal reasonably expects you to do with the Principal’s property;
• If you do not know the Principal’s expectations, act in the Principal’s best interest;
• Act in good faith;
• Do nothing beyond the authority granted in this Power of Attorney; and
• 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:

• Act loyally for the Principal’s benefit;
• Avoid conflicts that would impair your ability to act in the Principal’s best interest;
• Act with care, competence, and diligence;
• Keep a record of all receipts, disbursements, and transactions made on behalf of the principal;
• 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 interest; and
• Attempt to preserve the Principal’s estate plan if you know the plan and preserving the plan is consistent with the Principal’s best interest.

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:

• Death of the Principal;
• The Principal’s revocation of the Power of Attorney or your authority;
• The occurrence of a termination event stated in the Power of Attorney;
• The purpose of the Power of Attorney is fully accomplished; or
• 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 (Section IX) 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 as an Agent is defined in the Uniform Power of Attorney Act 14 V.S.A. §4001 et seq.  If you violate the Uniform Power of Attorney Act 14 V.S.A. §4001 et seq. 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.