Fill and Sign the Representing Yourself State of Maine Judicial Branch Form

STATE OF VERMONT SUPERIOR COURT FAMILY DIVISION ______________ Unit Docket No.______________ Plaintiff Defendant Name DOB v. Name DOB NOTICE OF APPEARANCE and INTENT TO REPRESENT MYSELF I intend to represent myself and hereby enter my appearance w ith the court. No attorney will represent me in this case unless an attorney or I notify the court otherwise. I understand that IT IS MY RESPONSIBILITY to: 1. Notify the Court in writing if I change my address or phone num ber; and 2. Send copies of any papers I file with the court to the other par ty in this case. All court papers may be mailed to me by first class mail at t he address listed below. My Street Address My Mailing Address (if different): Town/City State Zip Town/City State Zip Phone Number (day) ( ) Phone Number (day) ( ) E Mail Address PETITION FOR WAGE WITHHOLDING Pursuant to 15 V.S.A. §782 1. I am the
Plaintiff
Defendant
Office of Child Support 2. The other party is the
Plaintiff
Defendant 3. On , the other party was ordered to pay:



$__________ per _____________ in Child Support



$__________ per _____________ in Maintenance Supplement



$__________ per _____________ in Spousal Maintenance (Ali mony) 4. The order was issued by:



this court



another court_______________________________________ ____________ Name and address of Court 5. The other party has failed to pay to make payments as ordered by the Court. Form 809 6. The other party owes the following amounts:



$________________ in child support owed to me.



$________________ in child support maintenance supplemen t owed to me.



$________________ in spousal maintenance owed to me.



$________________ in child support owed to the State of Verm ont. 7. Some or all of these amounts are 7 days overdue. 8. A Case Accounting Affidavit from OCS:



Is attached.



Is not attached. 9. The other party’s employment:



The name of the other party’s employer is: ________________ ______________.



I do not know the name of the other party’s employer



The other party is self-employed.



The other party is unemployed REQUEST TO THE COURT I request that the Court:



Enter a Judgment against the the other party for all unpaid su pport.



Order Wage Withholding from the the other party’s wages in th e following amounts: $____________ per month for current support; $____________ per month towards the arrearage balance;



Order that such amounts be paid directly to the Office of Chil d Support on my behalf.



Grant any other relief this Court determines is appropriate . I hereby swear or affirm that the information above is true t o the best of my knowledge and belief. Signed and sworn to before me: AT HEARING THE OTHER PARTY MAY OBJECT TO WAGE-WITHHOLDING ON THE BASIS OF AN ERROR IN THE AMOUNT OF CURRENT SUPPORT OR ARREARAGES OR AN ERROR IN IDENTITY. Signature of Plaintiff Date Date Signature of Notary Public Expiration Date