Form 814 Vermont Family Court COMPLAINT FOR SUPPORT Name of Plaintiff County Docket Number Name of Defendant v. 1. (a) Plaintiff is: (1) the person named above seeking support. (2) the Office of Child Support, the state agency to whom the person seeking support named above has assigned rights of child support, located in Waterbury, Vermont. (3) other: Town/City County State (b) Plaintiff resides in: 2. (a) Defendant is: (1) the spouse of the person seeking support. (2) the adoptive parent of the child(ren) named in this complaint. (3) the stepparent of the child(ren) named in this complaint. (4) other: Town/City County State (b) Defendant resides in: 3. The following child(ren) is/are the subject of this complaint: 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 4. The defendant has deserted or without just cause has failed to furnish suitable support for: (a) the person named above seeking support. (b) the child(ren) named above. 5. The following actions for divorce, annulment, abuse prevention or separate support have been brought previously by either party against the other: None, or: ( 6. A certified copy of the complaint and docket entries in the previous action is attached.) Plaintiff Defendant receives or has received public assistance from the VT Department of Social Welfare. PLAINTIFF REQUESTS THE FOLLOWING RELIEF: the defendant legal rights and responsibilities for the 1. That the Court award the plaintiff minor child(ren). the defendant physical rights and responsibilities for 2. That the Court award the plaintiff the minor child(ren). the defendant suitable parent/child contact. 3. That the Court award the plaintiff 4. That the Court award payment of suitable child support and medical support for the child(ren). the defendant suitable maintenance supplement. 5. That the Court award the plaintiff the defendant suitable spousal maintenance. 6. That the Court award the plaintiff 7. That the Court award the plaintiff costs and attorney's fees. for ANFC 8. That the Court grant judgment to the Office of Child Support for $ debt due and owing by the defendant and determine a periodic amount to be paid by the defendant to be applied toward the debt. Date 9. Such other relief as is just and equitable. Signature of Plaintiff Subscribed and sworn to before me: Date Rev. 6/03 SML Signature or Notary Public Expiration Date American LegalNet, Inc. www.FormsWorkflow.com