Johnson City Community Concert Band Donor Document

STATE OF VERMONT SUPERIOR COURT FAMILY DIVISION
Complaint & Summons – Parentage

Unit Docket No.

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:

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 Complaint 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 Complaint. If you believe the Plaintiff should not be given everything requested 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.

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:

Family Division Mailing Addresses:

COMPLAINT FOR ESTABLISHMENT OF PARENTAGE AND RELATED OBLIGATIONS

FACTUAL INFORMATION

The Plaintiff states that the following facts are true:

1. Minor Children:

Name of Child:   Date of Birth:

Name of Child:   Date of Birth:

Name of Child:   Date of Birth:

2. Plaintiff is:

the biological or adoptive mother of the children named above;

the biological or adoptive father of the children named above;

a child named above;

a personal representative of a child named above;

Other:

3. Defendant is:

the biological or adoptive mother of the 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:

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.

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.

5. Public Assistance

I receive assistance from the Division of Economic Services.

Defendant receives public assistance from the Division of Economic Services.

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.

Type of Action / Who Filed / Where Filed / Year Filed

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.

Type of Action / Who Filed / Where Filed / Year Filed

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. 818M or Form No. 818F) is attached in support of the facts alleged in this Complaint.

A certified copy of a Voluntary Acknowledgment of Parentage is attached.

A copy of a genetic testing report is attached.

REQUEST FOR RELIEF

I ask that the Family Court grant the following requests (check each box that applies)

Parentage Order: A finding that the parties are the parents of the child(ren) named in section one of this complaint.

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

Parent Child Contact for Plaintiff Defendant

Child support and medical support for the minor child(ren)

Court costs

Attorney fees

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.

I hereby swear or affirm that the information above is true and correct to the best of my knowledge and belief.

Signed and sworn to or affirmed before me: