400-00840 226 Notice of Appearance & Intent to Represent Myself + Answer to Complaint (07/2018) Page 1 of 2 STATE OF VERMONT SUPERIOR COURT FAMILY DIVISION Unit Docket No. Plaintiff Name Defendant Name v . NOTICE OF APPEARANCE and INTENT TO REPRESENT MYSELF I intend to represent myself and hereby enter my appearance with 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 number; and 2. Send copies of any papers I file with the Court to the other party in this case. All Court papers may be mailed to me by first class mail at the address listed below. Name: Street Address: City/State/Zip: Mailing Address (if different from Street Address): City/State/Zip: Email Address: Daytime Phone: Evening Phone: ANSWER TO COMPLAINT I am the Defendant in this case. This is my answer to the facts in the Plaintiff222s Complaint: (Please refer to the Plaintiff222s Complaint and check whether you agree or disagree with the facts in each paragraph of the Complaint.) Agree Disagree Don222t Know 1. Minor Child ( ren ) 2. Relationship of Plaintiff to Child ( ren ) 3. R elationship of Defendant to the Child ( ren ) 4. Other possible parents 5. Jurisdiction 6. Facts related to the UCCJEA Jurisdiction 7. Public Assistance 8. Earlier Actions for Parentage or Separate Support 9. Relief from Abuse or Protective Order Proceeding 10. Military Status If you disagree with any of the facts in Plaintiff222s Complaint, please write the paragraph number below and state the facts you believe to be true: American LegalNet, Inc. www.FormsWorkFlow.com 400-00840 226 Notice of Appearance & Intent to Represent Myself + Answer to Complaint (07/2018)Page 2 of 2 COUNTER CLAIM I ask that the Family Court grant the following requests (check each box that applies) 1. Parentage Order: A finding that , andName Name (if applicable) are the parents of the child(ren) named in the complaint. Name 2. Parental Right and ResponsibilitiesLegal parental rights and responsibilities: Shared jointlyGiven solely to PlaintiffDefendantOtherPhysical parental rights and responsibilities:Shared jointlyGiven solely toPlaintiffDefendantOther3. Parent Child Contact for PlaintiffDefendantOther4.Name change of child(ren)Not seeking name changeOrder that the names of the child(ren) be changedIs now changed to Is now changed to Is now changed to Is now changed to Is now changed to 5. Order Genetic Testing 6. Child support and medical support for the minor child(ren)7. Court costs8. Attorney feesI hereby swear or affirm that the information above is true to the best of my knowledge and belief. Dated Signature Defendant Signed and sworn to or affirmed before me: Quick Reference Guide: NOTE if you are unsure if you meet the criteria to be established as a 223parent224, seek legal advice before submitting this Complaint with the Court. 223Presumed parent224 means a person who is married to the person who gave birth to the child(ren) during the marriage or a person who is married to the person who gave birth to the child(ren) and the child(ren) is/are born no later than 300 days after the marriage is terminated. 223Acknowledged parent224 means a person who has given birth to the child(ren) or who is the alleged genetic parent that has signed a Voluntary Acknowledgement of Parentage form. 223Adjudicated parent224 means a person who has been adjudicated by a Court of competent jurisdiction to be a parent of a child(ren). 223De Facto Parent224 is a person who has resided with the child(ren) as a regular member of the household for a significant period of time 223Intended parent224 is a person, whether married or unmarried, who manifests the intent to be legally bound as a parent of a child(ren) resulting from assisted reproduction or a gestational carrier agreement Date Signature of Notary Public Expiration Date American LegalNet, Inc. www.FormsWorkFlow.com