400-00817 - Complaint & Summons 226 Parentage (/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: 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: Other possible parent, if any (notice will be sent): 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 Name of PlaintiffHAS FILED A COMPLAINT TO ESTABLISH PARENTAGE AND RELATED OBLIGATIONS for certain minorchildren. The children are named in the Complaint which begins on the next page. Do not throw thesepapers 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 anAnswer. You can get an official court form for an Answer to a Parentage Complaint at any Vermont FamilyCourt or on the Judiciary web site at: http://www.vermontjudiciary.org American LegalNet, Inc. www.FormsWorkFlow.com 400-00817 - Complaint & Summons 226 Parentage (/2018) Page 2 of 6 3.YOU MUST RESPOND TO EACH CLAIM. In your Answer, you must state whether you agree or disagreewith each paragraph of the Complaint. If you believe the Plaintiff should not be given everything requestedin 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 REQUIRED TO NOTIFYYOU OF HEARINGS. If you do not attend the court hearings, the Plaintiff may receive everything requestedin the Complaint. 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 Answer to the Plaintiff222s 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 muststill 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 226 Parentage (/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 abovepresumed parentacknowledged parentadjudicated parentde facto parent*intended parenta personal representative of a child named aboveOther: 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 parentacknowledged parentadjudicated parentde facto parent*intended parentOther: 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 223parent224, please 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) was/were born no later that 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 if 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 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 226 Parentage (/2018) Page 4 of 6 Other possible parents (check one)The child(ren) do not have any other parents.ORThe child(ren) do have another parent named above. That parent222s name is: and his/her address is: .The nature of the relationship is (please describe).The court has jurisdiction because:Defendant resides in VermontDefendant does not reside in Vermont (check all box that appliesDefendant is personally served with notice of the proceeding within VermontDefendant submits to the Jurisdiction of Vermont by consent in a record by entering a generalappearance, or by filing with the tribunal a responsive document having the effect of waivingany contest to personal jurisdictionDefendant resided with the 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) resides in Vermont as a result of the acts or directives of the DefendantDefendant engaged in sexual intercourse in Vermont and the child(ren) may have beenconceived by that act of intercourseDefendant asserted parentage of a child(ren) in the putative father registry maintained inVermont by the Probate Division of Superior Court in the District of ChittendenAny other basis consistent with the constitution of Vermont and the United States for theexercise of personal jurisdiction6.UCCJEA Jurisdiction:A.During the last five years, the children listed above have lived at the following addresses with thefollowing household members: (Begin with the child222s residence just before this court case and list all addressesfor the past five years.) Information required under 15 V.S.A. 247 1071Address 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 theaddress listed above, please provide a current address for that person in the box above or onanother page. American LegalNet, Inc. www.FormsWorkFlow.com 400-00817 - Complaint & Summons 226 Parentage (/2018) Page 5 of 6 C.Please check the box below if the statement next to it is true. For each box you check, pleaseexplain your answer on another page.I have participated as a party, witness, or in some other way in a court case about the custody ofthis 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 aVermont 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 thischild or these children or who claims to have custody of or visitation rights with this child orthese children. 7.Public AssistanceI receive assistance from the Division of Economic ServicesDefendant receives public assistance from the Division of Economic ServicesOther possible parent receives public assistance from the Division of Economic Services 8.Earlier action fo