Vermont Funeral Resources & Education
  • Home
  • How To
    • Get Help Now
    • Learn the Law
    • Have a Home Funeral
    • Perform Body Care >
      • Cooling Techniques
    • Complete Paperwork
    • Arrange Disposition
    • Transport the Dead
    • Create Ceremony
    • Go Out Greener
    • Pay for a Funeral
    • Work with Professionals
  • Learn More
    • VT Funeral Home Price Survey
    • Green Burial in Vermont
    • Shop Local
    • Resources for Professionals
    • Tools for Community Education
    • Books, Articles, Organizations
    • Glossary
    • Sample Forms
    • Special Circumstances >
      • Pandemic Care Guide
      • Practical Guidelines
      • Ceremony Resources
  • FAQs
  • Contact

Designation of Agent Form

Download PDF here
Designation of Agent for After Death Arrangements

My Agent shall have full power and authority to act on my behalf, but only to the extent permitted by this Designation of Agent. 
 
I hereby grant to my Agent the full right, power, and authority to do every act, deed, and thing necessary or advisable to be done regarding the above power, as fully as I could do if personally present and acting.
 
My agent shall not be liable for any loss that results from a judgment error that was made in good faith. However, my agent shall be liable for willful misconduct or the failure to act in good faith while acting under the authority of this power of attorney.
 
(Print) I, ___________________________________________, of ______________________________ do hereby designate ___________________________________________________of ______________________________ as my Designated Agent.
Signature: ___________________________________________________________________Date: ____________________________
Address: _______________________________________________________________________________________________________


WITNESSES
I declare under penalty of perjury under the laws of the State of ___________________________ that the person who signed or acknowledged this document is personally known to me to be the principal, or that the identity of the principal was proved to me by convincing evidence; that the principal signed or acknowledged this durable power of attorney in my presence, that the principal appears to be of sound mind and under no duress, fraud, or undue influence; that I am not the person appointed as attorney in fact of this document; and that I am not the principal’s health care provider, an employee of the principal’s health care provider, the operator of a community care facility or a residential care facility for the elderly, nor an employee of an operator of a community care facility or residential care facility for the elderly.
 
I further declare under penalty of perjury under the laws of this State that, to the best of my knowledge, I am not entitled to any part of the estate of the principal upon the death of the principal under a will now existing or by operation of law.
                                                                                                                                                                                                                                                                                                
Witness 1 Signature: ____________________________________________________                                                                                     
Print name __________________________________________________ Date _____________________________
Address _________________________________________________________________
 
Witness 2 Signature: ____________________________________________________
Print name __________________________________________________ Date ______________________________
Address _________________________________________________________________

Learn How To:
Perform Body Care
Complete Paperwork
Arrange Disposition
Transport the Dead
Create Ceremony
Go Out Greener
Work with Professionals
​Pay For a Funeral
Learn About:
How to Get Help
Vermont Funeral Law
Professional Education
Community Education
Home Funeral Resources
FAQs
​Glossary of Terms
Stories
(coming soon)oon)
Vermont Funeral Resources
​and Education
 

[email protected]

​Contact
Vermont Funeral Resources and Education is a non-commercial public interest site dedicated to helping Vermont consumers care for their own dead with or without the assistance of a funeral director. All rights reserved  © FuneralPartnership.org
Picture
Landscape photos courtesy of
Jim Thompson

Vermont Lenses
[email protected]
All Rights Reserved

Proudly powered by Weebly
  • Home
  • How To
    • Get Help Now
    • Learn the Law
    • Have a Home Funeral
    • Perform Body Care >
      • Cooling Techniques
    • Complete Paperwork
    • Arrange Disposition
    • Transport the Dead
    • Create Ceremony
    • Go Out Greener
    • Pay for a Funeral
    • Work with Professionals
  • Learn More
    • VT Funeral Home Price Survey
    • Green Burial in Vermont
    • Shop Local
    • Resources for Professionals
    • Tools for Community Education
    • Books, Articles, Organizations
    • Glossary
    • Sample Forms
    • Special Circumstances >
      • Pandemic Care Guide
      • Practical Guidelines
      • Ceremony Resources
  • FAQs
  • Contact