400 - 00817 - Complaint & Summons Parentage (0 7 /2018) Page 1 of 6 STATE OF VERMONT SUPERIOR COURT FAMILY DIVISION Unit Docket No. Plaintiff Name Defendant Name v . SUMMONS AND COMPLAINT TO ESTABLISH PARENTAGE 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 Address (if different from Street Address) : City/State/ Zip: Email Address: Daytime Phone: Evening Phone: Attorney Name: Attorney Phone: Other possible parent , if any (notice will be sent) : Name: Date of Birth: Street Address: City/State/Zip: Maili ng 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 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 American LegalNet, Inc. www.FormsWorkFlow.com 400 - 00817 - Complaint & Summons Parentage (0 7 /2018) Page 2 of 6 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 the court hearings, the Plaintiff may receive everything requested in the C omplaint. 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 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 American LegalNet, Inc. www.FormsWorkFlow.com 400 - 00817 - Complaint & Summons Parentage (0 7 /2018) Page 3 of 6 VERIFIED 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: Name of Child : Date of Birth: Name of Child : Date of Birth: 2. Plaintiff is (check all that apply) : the genetic or adoptive mother of the children named above; the genetic or adoptive father of the children named above; a child named above presumed p arent acknowledged p arent adjudicated p arent de f acto p arent * intended p arent a personal representative of a child named above Other : state the nature of parental relationship to the child(ren) 3. Defendant is (check all that apply) : the genetic or adoptive mother of the children named above; the genetic or adoptive father of the children named above; presumed p arent acknowledged p arent adjudicated p arent de f acto p arent * intended p arent Other : state the nature of parental relationship to the child(ren) * A party filing as a de facto parent must file an additional affidavit. See information pamphlet for details Quick Reference Guide: NOTE if you are unsure if you meet the criteria to be established as a seek legal advice before submitting this complaint with the court . 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) was/were born no later that 300 days af ter the marriage is terminated . 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 . means a person who has been adjudicated by a court of competent jurisdiction to be a parent of a child (ren) . if a person who has resided with the child(ren) as a regular member of the household for a significant period of time . is a person, whether married or unmarried, who intends to be legally bound as a parent of a child (ren) resulting from assisted reproduction or a gestational carrier agreement . American LegalNet, Inc. www.FormsWorkFlow.com 400 - 00817 - Complaint & Summons Parentage (0 7 /2018) Page 4 of 6 4. Other possible parents (check one) The child(ren) do not have any other acknowledged, adjudicated, intended or presumed parents OR The child(ren) do have an other acknowledged, adjudicated, intended or presumed parent not named above . and their address is: . The nature of the relationship is ( please describe ) 5. The court has jurisdiction because : Defendant resides in Vermont Defendant does not reside in Vermont (check all box that applies Defendant is personally served with notice of the proceeding within Vermont Defendant submits to the Jurisdiction of Vermont by consent in a record by entering a general appearance , or by filing with the tribunal a responsive document having the effect of waiving any contest to personal jurisdiction Defendant resided with t he child(ren) in Vermont from to Date Date Defendant resided in Vermont and provided prenatal expenses or support for the child(ren) The child(ren) reside s in Vermont as a result of the acts or directives of the Defendant Defendant engaged in sexual intercourse in Vermont and the child(ren) may have been conceived by that act of intercourse Defendant asserted parentage of a child (ren) in the putative father registry maintained in Vermont by the Probate Division o f Superior Court in the District of Chittenden Any other basis consistent with the constitution of Vermont and the United States for the exercise of personal jurisdiction 6. UCCJEA Jurisdiction: A. During the last five years, the children listed above have lived at the following addresses with the following household members: t his court case and list all addresses for the past five years.) Information req uired under 15 V.S.A. 247 1071 Address Dates Names 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 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 that person in the box above or on another page. American LegalNet, Inc. www.FormsWorkFlow.com 400 - 00817 - Complaint & Summons Parentage (0 7 /2018) Page 5 of 6 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. 7. Public Assistance I receive assistance from th e Division of Economic Services Defendant receives public assistance from the Division of Economic Services Other possible parent receives public assistance from the Div