Fill and Sign the An Order for Relief from Abuse Was Entered in the above Case on Form

Form 153 STATE OF VERMONT MOTION TO MODIFY/EXTEND/VACATE RELIEF FROM ABUSE ORDER An Order for relief from abuse was entered in the above case on: Date requests that this Order of the Court be: The Plaintiff Defendant Rev. 7/10 SML Modified as follows: Extended until (date) Vacated. . In support of this request, subject to the penalties for perjury, I state the following facts to be true to the best of my knowledge and belief. Specifically describe the facts that support your request. Signature of Petitioner Date Subscribed and sworn to before me. Signature of Notary Public Date Expiration Date NOTICE! This affidavit will be served on opposing party with the motion to modify/extend/vacate relief from abuse. Affidavit in Support of Request: Distribution: Original ~ Court; 1 Copy ~ Plaintiff; 1 Copy ~ Defendant; 1 Copy ~ File WARNING: MAKING FALSE STATEMENTS IN THIS AFFIDAVIT IS A CRIME SUBJECT TO A TERM OF IMPRISONMENT OR A FINE, OR BOTH AS PROVIDED BY 13 V.S.A. §2904. STATE OF VERMONT SUPERIOR COURT FAMILY DIVISION Unit Docket No. v. Defendant's Name DOB / / Plaintiff's Name DOB / /