Vermont Statutes Title 12. Court Procedure, § 6041. Indictment--Perjury before court or tribunal

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 of ․․․․․․․․․․, on the ․․․․․․․․․․ day of ․․․․․․․․․․ A.D. 20․․․, appeared as a witness in a proceeding in which C.D. and E.F. were parties, then and there being heard before a tribunal of competent jurisdiction, (here specify the matter under consideration) and committed the crime of perjury, by testifying in substance as follows: (here set out the matter sworn to and alleged to be false) which such testimony was material to the issue then and there pending in such proceeding, against the peace and dignity of the State.