Vermont Limited (Special) Power of Attorney Form

The Vermont limited (special) power of attorney form is used to allow the Principal to delegate an Attorney-in-Fact to undertake and perform only the acts specified within the document, thus limiting or specializing the power bestowed.

If the document has been completed properly, it will provide a detailed list of tasks, provide both the Principal’s name as well as their chosen and compliant Attorney-in-Fact, it will be signed by the Principal, and the signature will have been acknowledged by the Principal in front of a Notary Public and at least one other witness (VA Code § 64.2-1603).

How to Write

Step 1 – The Parties – Enter the following information:

  • The full name of the Principal
  • Principal’s Social Security Number
  • AND
  • Enter the Agent’s full name
  • Agent’s physical address
  • Agent’s telephone number

Step 2 – Approved Powers –

  • The Principal may enter the powers they wish to grant to the selected Agent
  • If added space is needed, add a continuation sheet
  • The Principal must review and agree to the remaining information

Step 3 – Signature – Enter the following:

  • Enter the date of the signature in dd/mm/yyyy format
  • Principal must enter their signature