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400 - 00817 – Complaint & Summons – Parentage ( 01 /2018 ) Page 1 of 5 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: ___________________________________ _____ Attorn ey Phone: __________ __________ _____ Defendant Information: Name: _______________________________ _______ __________ Date of Birth: _____________________ _______ Street Address: _________________________________________ City/State/Zip: ___________________________ Mailing Addr ess (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 _____________________________________ ______________________________ ___ ______ Name of Plaintiff HAS FILED A COMPLAINT TO ESTABLISH PARENTAGE AND RELATED OBLIGATIONS for certain minor children. The children are named in the C omplaint which 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 Parentage 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 C omplaint. If you believe the Plaintiff should not be given everything requested in the C omplaint, you should say so in your A nswer. 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 t he 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 - 00817 – Complaint & Summons – Parentage ( 01 /2018 ) Page 2 of 5 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 A nswer 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 400 - 00817 – Complaint & Summons – Parentage ( 01 /2018 ) Page 3 of 5 COMPLAINT FOR ESTABLISHMENT OF PARENTAGE AND RELATED OBLIGATIONS FACTUAL INFORMATION The Plaintiff states that the following facts are true: 1. Minor Children: The children who are the subject of this parentage action are: Name of Child : ______________________________________ Date of Birth: ____________________________ Name of Child : ______________________________________ Date of Birth: ____________________________ Name of Child : ______________________________________ Date of Birth: ____________________________ 2. Plaintiff is: ☐ th e biological or adopt ive mother of th e children named above; ☐ th e biological or adopt ive father of th e children named above; ☐ a child named above; ☐ a personal representative of a child named above ; ☐ Other: ________________________________________________________________________\ ___ 3. Defendan t is: ☐ th e biological or adopt ive mother of th e children named above; ☐ the biological or adoptive father of the children named above; ☐ Other: ________________________________________________________________________\ ___ 4. 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 his court case and list all addresses for the past five years.) Address Dates N ames of all Persons (include street/city/state) (from when to when) ( living in the household with the child ) _________________________________ ______________ ___________________________ _________________________________ ______________ ____________________ _______ _________________________________ ______________ ___________________________ Use additional page if you need more space. If children have lived at different addresses from each 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 above 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 with this child or these children. 400 - 00817 – Complaint & Summons – Parentage ( 01 /2018 ) Page 4 of 5 5. Public Assistance ☐ I receive assistance from the Division of Economic Services . ☐ Defendant receives public assistance from the Division of Economic Servi\ ces .6. Earlier action for parentage, divorce, annulment or separate support ☐ I have not filed for establishment of parentage, divorce, legal separation, annulment or separate support in any court against the defendant AND, as far as I know, the defendant has not brought an action for parentage, divorce, legal separation, civil union, annulment or separate support against me. ☐ I have filed or the Defendant has filed for establishment of parentage, divorce, legal separation, annulment or separate support before the date of the filing of this petition. (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. 7. 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. 8. 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. 9. Verification ☐ My parentage affidavit (Form No. 818 M or Form No. 818F ) is attached in support of the facts alleged in this Complaint. ☐ A certified copy of a Volunt ary Acknowledgment of Parent age is attached. ☐ A copy of a genetic testin g report is attached. 400 - 00817 – Complaint & Summons – Parentage ( 01 /2018 ) Page 5 of 5 REQUEST FOR RELIEF I ask that the Family Court grant the following requests (check each box that applies ) 1. ☐ Parentage Order: A finding that the parties are the parents of the child(ren) named in section one of this complaint. 2. ☐ Parental Right and Responsibilities Legal parental rights and responsibilities: ☐ Shared jointly ☐ Given solely to ☐ Plaintiff ☐ Defendant Physical parental rights and responsibilities: ☐ Shared jointly ☐ Given solely to ☐ Plaintiff ☐ Defendant 3. ☐ Parent Child Contact for ☐ Plaintiff ☐ Defendant 4. ☐ Child support and medical support for the minor child(ren) 5. ☐ Court costs 6. ☐ Attorney fees 7. ☐ I have attached a written agreement signed by Defendant and myself. I ask that the Court issue an order that includes the provision 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 and correct 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