Form 89 STATE OF VERMONT FAMILY DIVISION Docket No. DOB / / SUPERIOR COURT Unit In Re: CARE PLAN FOR CHILD (Use another page if needed) As a non-custodial parent, I am requesting temporary legal custody of (list names of child(ren)) under 33 V.S.A. §5308 (b). 1. My Name: 2. I have had contact with my child(ren) as follows: My contact has been regular. My contact has not been regular for these reasons: I have Court ordered contact through a Issued in state of divorce parentage order unit of 3. My plan for meeting my child(ren)'s needs for a safe, secure, and stable home is the following: (please be specific) 4. My plan will provide proper and effective care and control for my child(ren) because: 5. Contact with custodial parent: My plan for contact between my child(ren) and the custodial parent is: I do not think contact between my child(ren) and the custodial parent is appropriate because: Signature, non-custodial parent 07/10 SML Date American LegalNet, Inc. www.FormsWorkFlow.com