Fill and Sign the State of Vermont Unit Docket No Plaintiff Defendant Notice Form

Form 816 COMPLAINT FOR LEGAL SEPARATION Town/City State County 1. (a) Plaintiff resides in Date Plaintiff has resided in Vermont continuously until the present day since (b) State Town/City County 2. (a) Defendant resides in Date Defendant has resided in Vermont continuously until the present day since (b) Town/City State Date 3. Plaintiff and Defendant were married on at 4. The following minor children were born of said marriage: 5. The parties own the following property singly or jointly (attach additional page if you need more space): 6. The following actions for divorce, annulment, abuse prevention or separate support have been brought previously by either party against the other: None, or: A certified copy of the complaint and docket entries in the previous action is attached. 7. Defendant has/will have lived separate and apart from the plaintiff for six consecutive months and the resumption of a marital relationship is not reasonably probable. The parties separated on Date Defendant receives or has received public assistance from the Economic Services Division. Plaintiff 8. PLAINTIFF REQUESTS THE FOLLOWING RELIEF: 1. That the Court grant plaintiff a legal separation. the defendant 2. That the Court award the plaintiff minor children. physical rights and responsibilities for 3. That the Court award the plaintiff the minor children. suitable parent/child contact. 4. That the Court award the plaintiff 5. That the Court award payment of suitable child support and medical support. suitable maintenance supplement. suitable spousal maintenance. a suitable portion of the the plaintiff 6. That the Court award 7. That the Court award the plaintiff 8. That the Court award the plaintiff 9. That the Court award the plaintiff costs and attorney's fees. 10. Such other relief as is just and equitable. Date Signature of Plaintiff Subscribed and sworn to before me: Expiration Date Signature or Notary Public Date Rev. 3/05 SML Vermont Docket Number County Family Court Plaintiff Defendant VS. property of the marriage. legal rights and responsibilities for the the defendant the defendant the defendant the defendant the defendant Name of Child Date of Birth Name of Child Date of Birth Name of ChildDate of Birth Name of Child Date of Birth Name of Child Date of Birth Date of Birth Name of Child SELECT COUNTY