Fill and Sign the This Summons is Directed to Form

400-00836 Children – Complaint for Divorce/Legal Separation/Dissolution with Children (01/2018) Page 1 of 6 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: ___________________________________ 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: __________________ Name of Defendant 1. PLAINTIFF _________________________________________________ IS SEEKING A Name of Plaintiff ☐DIVORCE ☐ LEGAL SEPARATION ☐ CIVIL UNION DISSOLUTION The Plaintiff’s Complaint begins on the next page. Do not throw these papers away. They are offi cial 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 Divorce Comp laint 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 s hould not be given everything asked for 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 REQUIR ED 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. 400-00836 Children – Complaint for Divorce/Legal Separation/Dissolution with Children (01/2018) Page 2 of 6 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 P laintiff’s attorney. 6. YOU MUST GIVE OR SEND YOUR ORIGINAL ANSWER TO THE COURT at this addr ess: 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 Select Address 400-00836 Children – Complaint for Divorce/Legal Separation/Dissolution with Children (01/2018) Page 3 of 6 COMPLAINT FOR DIVORCE/LEGAL SEPARATION/DISSOLUTION FACTS The Plaintiff states that the following facts are true: 1. Residence: (A) I am now a resident of , . County State ☐ I have resided in Vermont for 6 full months. (B) Defendant is now a resident of _, . County State ☐ Defendant has resided in Vermont for 6 full months. 2. ☐ Marriage: We were married at , ___ ________________ City State on and are still married. Month/ Date/Year ☐ Civil Union: Our civil union took place at , ___________________ City State on and it has never been dissolved. Month/ Date/Year 3. Grounds for Divorce/Legal Separation/Dissolution: The reason I am asking for a ☐ Divorce ☐ Legal Separation ☐ Dissolution Is that: ☐ Six Month Separation: We have or will have lived separate and apart for more than six (6) consecutive months and it is not reasonably probable that we can resume ou r relationship. The Defendant and I separated on: _____________________________. M onth/Date/Year – this field is required ☐ Other: (Please explain) 4. Minor Children of the Parties: We have children of our marriage who are either younger th an 18 years old, or are 18 years old and still in high school. Include born or adopted childre n. Name of Child Date of Birth _______________________________________________ _________________________ _______________________________________________ _________________________ _______________________________________________ _________________________ _______________________________________________ _________________________ _______________________________________________ _________________________ 400-00836 Children – Complaint for Divorce/Legal Separation/Dissolution with Children (01/2018) Page 4 of 6 5. UCCJEA Jurisdiction: Information required under 15 V.S.A. § 1071 (A) During the last five years the children listed above have li ved at the following addresses with the following household members: (Begin with the child’s residence just before this court case started and list all addresses for the past five years.) Address Dates Name of All Persons Living (Include street/city/state) (From when to when) in the Household with the Child _____________________________________ _______________ ____________________ _____________________________________ _______________ ____________________ _____________________________________ _______________ ____________________ Use an additional page if you need more space. If children have lived at different a ddresses from each other 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 th at person in the box or on another page. (C) Please check the box below if the statement next to it is true. For ea ch 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 to this child or these children. 6. Property, Assets and Debts: I have listed all of the property, assets and debts that my spouse and I own either together or separately that are known to me, in the Fin ancial Affidavit that I am filing with this Complaint (form 400-00813B). 7. Public Assistance: ☐ I receive assistance from the Division of Economic Services. ☐ The Defendant receives public assistance from the Division of Economic S ervices. 400-00836 Children – Complaint for Divorce/Legal Separation/Dissolution with Children (01/2018) Page 5 of 6 8. Earlier actions for divorce, legal separation, dissolution , annulment: ☐ I have not filed for divorce, legal separation, dissolution or annulment in any court against the Defendant, as far as I know, the Defendant has not filed for divorce, legal sep aration, dissolution or annulment against me. ☐ I have filed OR the Defendant has filed for divorce, legal separation, dissolut ion or annulment before the date of the filing of this petition. ( If you check this box, you must fill in 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. 9. Relief from abuse or protective order proceedings: ☐ I have not filed a complaint for relief from abuse or a request for a p rotective 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. 10. 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. REQUEST FOR RELIEF ☐ 1. I ask that the Family Court grant me: (check each box that applies) ☐ Decree of Divorce ☐ Decree of Legal Separation ☐ Decree of Dissolution ☐ 2. Parental Right and Responsibilities Legal parental rights and responsibilities: ☐ Shared jointly ☐ Given solely to: ☐ Myself ☐ Defendant Physical parental rights and responsibilities ☐ Shared jointly ☐ Given solely to: ☐ Myself ☐ Defendant ☐ 3. Parent Child Contact for: ☐ Myself ☐ Defendant ☐ 4. Child support, medical support and/or maintenance supplement. 400-00836 Children – Complaint for Divorce/Legal Separation/Dissolution with Children (01/2018) Page 6 of 6 ☐ 5. Division of Property (divide our property, assets and debts). ☐ 6. Spousal Maintenance (Alimony). ☐ 7. Court costs. ☐ 8. Attorney fees. ☐ 9. Name change: I would like to resume my former name of: . ☐ I have attached a written agreement signed by my spouse and myself. I ask that the Court issue an order that includes the provisions of our written agreeme nt. (In order to qualify for the reduced filing fee, the attached agreement must cover all the issues that the Plainti ff seeks to have the Court resolve.) I hereby swear or affirm that the information above is tru e 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