Vt. Stat. Ann. tit. 12, § 6043

Indictment Against a Person for Committing Perjury in Swearing

STATE OF VERMONT, Be it remembered that at a term.................... County, ss. } of the Superior Court begun and held at...................., within and for the county of...................., aforesaid, on the.................... day of.................... A.D. 20......., the grand jurors within and for such county of...................., upon their oath present, that A. B. of.................... in the county of...................., at.................... in such county, on the.................... day of.................... A.D. 20.........., before G. H., then and there having competent authority to administer oaths, committed the crime of perjury, by falsely swearing (or affirming) to material matter in writing required by law to be sworn to (here insert substance of writing ) signed by said A. B., which material matter is in substance as follows: ( here set out the matter in such writing claimed to be false ) against the peace and dignity of the State.