Vermont Judiciary Criminal Record Check Request and Reply . Form 331 www.vermontjudiciary.org Reply Date: Date of Request: Name of Requestor: Please type or print all information clearly Address: Mailing Address State City Zip 1) All requests for criminal court record searches shall be made in writing and received at the court's public service counter or by mail. A self addressed, stamped envelope must be included with each request. 2) Requests by phone, fax and e-mail shall not be accepted. 3) The person requesting the search shall pay a $30 fee in advance of the court staff performing the search. The fee covers the search and one written summary of cases, including each docket number, charge, disposition and disposition date. The fee does not cover copies of docket pages or other documents. • Search Fee $30.00 for each name listed below • Photocopies $ 0.25 per page (minimum charge of $1.00) • Certification $ 5.00 • Microfilmed Records Additional fees apply. The clerk's office will advise. 4) The search fee shall be collected for each search performed by court staff, regardless of whether any record is found. If no record is found, court staff shall provide a written statement indicating no record was located for the name and date of birth searched. 5) The request for search shall identify, at a minimum, the name and date of birth of the person that is the subject of the search. These two columns to be completed by requestor Name(s) to be checked D/O/B These columns reserved for District Court use only Record Y/N Docket # Charge(s) Disposition and Date This information is provided in response to a request for criminal history record check. However, the Vermont Judiciary does not guarantee the accuracy or completeness of the record search or the information provided. The Vermont Judiciary accepts no liability for any injury or damage sustained by any person or entity that relies on the record search or information provided. Rev. 6/08 SML American LegalNet, Inc. www.FormsWorkflow.com