COMPLAINT FOR LEGAL SEPARATION Form 816 Vermont Family Court County Docket Number Defendant Plaintiff VS. Town/City County State 1. (a) Plaintiff resides in Date (b) Plaintiff has resided in Vermont continuously until the present day since Town/City County State 2. (a) Defendant resides in Date (b) Defendant has resided in Vermont continuously until the present day since Town/City Date 3. Plaintiff and Defendant were married on State at 4. The following minor children were born of said marriage: 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 Name of Child Date of Birth 5. The parties own the following property singly or jointly (attach additional page if you need more space): 6. The following actions for divorce, annulment, abuse prevention or separate support have been brought previously by either party against the other: None, or: A certified copy of the complaint and docket entries in the previous action is attached. 7. Defendant has/will have lived separate and apart from the plaintiff for six consecutive months and the resumption of a marital relationship is not reasonably probable. The parties separated on Date 8. Plaintiff Defendant receives or has received public assistance from the Economic Services Division. PLAINTIFF REQUESTS THE FOLLOWING RELIEF: 1. That the Court grant plaintiff a legal separation. the defendant 2. That the Court award the plaintiff legal rights and responsibilities for the minor children. 3. That the Court award the plaintiff the defendant physical rights and responsibilities for the minor children. the defendant suitable parent/child contact. 4. That the Court award the plaintiff 5. That the Court award payment of suitable child support and medical support. the defendant suitable maintenance supplement. the plaintiff 6. That the Court award the defendant suitable spousal maintenance. 7. That the Court award the plaintiff 8. That the Court award the plaintiff the defendant a suitable portion of the property of the marriage. 9. That the Court award the plaintiff costs and attorney's fees. 10. Such other relief as is just and equitable. Signature of Plaintiff Date Subscribed and sworn to before me: Date Signature or Notary Public Expiration Date Rev. 3/05 SML American LegalNet, Inc. www.FormsWorkflow.com