Fillable Mailing Address (Vermont Judiciary)

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Mailing Address (Vermont Judiciary)

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400-00836Children – Complaint for Divorce/Legal Separation/Dissolution with Children (05/2020) Page 1 of 6
STATE OF VERMONT
SUPERIOR COURT
FAMILY DIVISION
Unit
Docket No.
Plaintiff Name
Defendant Name
v.
Plaintiff Information:
Name: __________________________________________ Date of Birth: __________________________
Street Address: ___________________________________ City/State/Zip: _________________________
Mailing Address
(if different from Street Address): _______________________________________________________
City/State/Zip: ____________________________________ Email Address: _________________________
Daytime Phone: ___________________________________ Evening Phone: ________________________
Attorney Name: ___________________________________ Attorney Phone: _______________________
Defendant Information:
Name: __________________________________________ Date of Birth: __________________________
Street Address: ___________________________________ City/State/Zip: _________________________
Mailing Address
(if different from Street Address): _______________________________________________________
City/State/Zip: ____________________________________ Email Address: _________________________
Daytime Phone: ___________________________________ Evening Phone: ________________________
Attorney Name: ___________________________________ Attorney Phone: _______________________
SUMMONS
THIS SUMMONS IS DIRECTED TO: __________________
Name of
Defendant
1. PLAINTIFF _________________________________________________ IS SEEKING A
Name of Plaintiff
☐ DIVORCE ☐ LEGAL SEPARATION ☐ CIVIL UNION DISSOLUTION
The Plaintiff’s Complaint begins on the next page. Do not throw these papers away. They are official
papers that affect your rights.
2. TO PROTECT YOUR RIGHTS, YOU SHOULD REPLY WITHIN 21 DAYS. Your written response is called an
Answer. You can get an official court form for an Answer to a Divorce Complaint at any Vermont
Family Court or on the Judiciary web site at http://www.vermontjudiciary.org.
3. YOU MUST RESPOND TO EACH CLAIM. In your Answer you must state whether you agree or disagree
with each paragraph of the Complaint. If you believe the Plaintiff should not be given everything
asked for in the Complaint, you should say so in your Answer.
4. IF YOU DO NOT FILE AN ANSWER OR FILE AN APPEARANCE, THE COURT IS NOT REQUIRED TO
NOTIFY YOU OF HEARINGS. If you do not attend the court hearings, the Plaintiff may receive
everything requested in the Complaint. You will not get a chance to tell your side of the story.
400-00836Children – Complaint for Divorce/Legal Separation/Dissolution with Children (05/2020) Page 2 of 6
5. YOU MUST GIVE OR SEND A COPY OF YOUR ANSWER TO THE PLAINTIFF. If the Plaintiff has an
attorney, you must give or send a copy of your Answer to the Plaintiff’s attorney.
6. YOU MUST GIVE OR SEND YOUR ORIGINAL ANSWER TO THE COURT at this address:
7. LEGAL ASSISTANCE: You may wish to get help from a lawyer. Even if you cannot get legal help, you
must still give the Court a written Answer to protect your rights.
Dated
_____________________________ ___________________________________
Signature of Court Clerk
Select Address
400-00836Children – Complaint for Divorce/Legal Separation/Dissolution with Children (05/2020) Page 3 of 6
COMPLAINT FOR DIVORCE/LEGAL SEPARATION/DISSOLUTION
FACTS
The Plaintiff states that the following facts are true:
1. Residence:
(A)
I am now a resident of , .
County State
☐ I have resided in Vermont for 6 full months.
(B)
Defendant is now a resident of _, .
County State
☐ Defendant has resided in Vermont for 6 full months.
2.
☐ Marriage:
We were married at , ___________________
City State
on
and are still married.
Month/Date/Year
☐ Civil Union:
Our civil union took place at , ___________________
City State
on
and it has never been dissolved.
Month/Date/Year
3.
Grounds for Divorce/Legal Separation/Dissolution: The reason I am asking for a
☐ Divorce ☐ Legal Separation ☐ Dissolution
Is that:
☐ Six Month Separation: We have or will have lived separate and apart for more than six (6)
consecutive months and it is not reasonably probable that we can resume our relationship.
The Defendant and I separated on: _____________________________.
Month/Date/Year – this field is required
☐
Other:
(Please explain)
4.
Minor Children of the Parties:
We have children of our marriage who are either younger than 18 years old, or are 18 years
old and still in high school. Include born or adopted children.
Name of Child Date of Birth
_______________________________________________ _________________________
_______________________________________________ _________________________
_______________________________________________ _________________________
_______________________________________________ _________________________
_______________________________________________ _________________________
400-00836Children – Complaint for Divorce/Legal Separation/Dissolution with Children (05/2020) Page 4 of 6
5.
UCCJEA Jurisdiction: Information required under 15 V.S.A. § 1071
(A)
During the last five years the children listed above have lived at the following addresses with
the following household members:
(Begin with the child’s residence just before this court case started and list all addresses for the
past five years.)
Address Dates Name of All Persons Living
(Include street/city/state) (From when to when) in the Household
with the Child
_____________________________________ _______________ ____________________
_____________________________________ _______________ ____________________
_____________________________________ _______________ ____________________
Use an additional page if you need more space. If children have lived at different addresses from each other please indicate
the addresses for each child.
(B)
If the current address of any household member listed in the last column is different from
the address listed above, please provide a current address for that person in the box or on
another page.
(C)
Please check the box below if the statement next to it is true. For each box you check,
please explain your answer on another page.
☐ I have participated as a party, witness, or in some other way in a court case
about the
custody of this child or these children in Vermont or another state.
☐ I have information about a case concerning this child or these children that is
now pending
in a Vermont court or a court in another state.
☐ I have knowledge about a person who is not a party to this case who has
physical custody
of this child or these children or who claims to have custody of or visitation rights to this
child or these children.
6.
Property, Assets and Debts: ☐ I am ☐ I am not filing with this Complaint, a completed
Financial form 400-00813B that lists all of the property, assets and debts that my spouse and
I own together or separately that are known to me
7.
Public Assistance:
☐ I receive assistance from the Division of Economic Services.
☐ The Defendant receives public assistance from the Division of Economic Services.
400-00836Children – Complaint for Divorce/Legal Separation/Dissolution with Children (05/2020) Page 5 of 6
8.
Earlier actions for divorce, legal separation, dissolution, annulment:
☐ I have not filed for divorce, legal separation, dissolution or annulment in any court against the
Defendant, as far as I know, the Defendant has not filed for divorce, legal separation, dissolution
or annulment against me.
☐ I have filed OR the Defendant has filed for divorce, legal separation, dissolution or annulment
before the date of the filing of this petition. (If you check this box, you must fill in the
information below. Use an additional page if necessary.)
Type of Action Who Filed Where Filed Year Filed
(Court, County, State)
________________ ______________ _____________________ __________
________________ ______________ _____________________ __________
________________ ______________ _____________________ __________
Please attach a copy of any Court Order issued in a case listed above.
9.
Relief from abuse or protective order proceedings:
☐ I have not filed a complaint for relief from abuse or a request for a protective order against
the Defendant AND, as far as I know, the Defendant has not filed such an action against me.
☐ I have filed a complaint for relief from abuse or a request for a protective order against the
Defendant OR the Defendant has filed a complaint for relief from abuse or a request for a
protective order against me. (If you check this box, you must complete the information below.
Use an additional page if necessary.)
Type of Action Who Filed Where Filed Year Filed
(Court, County, State)
________________ ______________ _____________________ __________
________________ ______________ _____________________ __________
________________ ______________ _____________________ __________
Please attach a copy of any Court Order issued in a case listed above.
10.
Military Service:
☐ The Defendant is in the military service.
☐ The Defendant is not in the military service.
☐ I am in the military service.
☐ I am not in the military service.
REQUEST FOR RELIEF
☐ 1. I ask that the Family Court grant me: (check each box that applies)
☐ Decree of Divorce ☐ Decree of Legal Separation ☐ Decree of Dissolution
☐
2. Parental Right and Responsibilities
Legal parental rights and responsibilities:
☐
Shared jointly
☐ Given solely to: ☐ Myself ☐ Defendant
Physical parental rights and responsibilities
☐
Shared jointly
☐
Given solely to:
☐ Myself ☐ Defendant
☐ 3. Parent Child Contact for: ☐ Myself ☐ Defendant
☐ 4. Child support, medical support and/or maintenance supplement.
400-00836Children – Complaint for Divorce/Legal Separation/Dissolution with Children (05/2020) Page 6 of 6
☐ 5. Division of Property (divide our property, assets and debts).
☐
6. Spousal Maintenance (Alimony).
☐
7. Court costs.
☐
8. Attorney fees.
☐ 9. Name change: I would like to resume my former name of: .
☐ I have attached a written agreement signed by my spouse and myself. I ask that the Court
issue
an order that includes the provisions of our written agreement. (In order to qualify for the reduced
filing fee, the attached agreement must cover all the issues that the Plaintiff seeks to have the Court
resolve.)
I hereby swear or affirm that the information above is true to the best of my knowledge and belief.
Dated
_____________________________ ___________________________________
Signature of Plaintiff
___________________________________
Printed Name
Signed and sworn to or affirmed before me:
Date Signature of Notary Public Expiration Date
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Mailing Address (Vermont Judiciary)

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Completed 30 July 2020

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