Form 800 Vermont COVER SHEET Family Court Your Name Docket Number County The Other Party's Name Street Address Street Address Mailing Address Mailing Address Town/City State Telephone Numbers Work: Home: Zip Code State Town/City Telephone Numbers Work: Cell: Home: Zip Code Cell: Date of Birth Date of Birth 1. Filing fee I am enclosing $ as my filing fee. Because of my financial circumstances, I am asking that the filing fee be waived. IFP attached. This form is being filed by OCS. 2. Service Fee I am enclosing $ to pay for service. Because of my financial circumstances, I am asking that the filing fee be waived. IFP attached. A service fee is not required. Complete sections 3 and 4 if you have minor children. 3. Public Assistance (e.g. Reach-Up; Dr. Dynosaur; Medicaid; Post Secondary Education Stipend (PSE)) a. I receive public assistance no yes b. The other party receives public assistance yes no don't know 4. Assistance from Office of Child Support (OCS) a. I receive assistance from OCS yes no b. The other party receives assistance from OCS yes no don't know The Office of Child Support can help people with child support. If you would like to have OCS help you, you can call the Toll-Free Help Line: 1-800-786-3214 or TTY Access Number 1-800-253-0191. 5. Other Family/Probate/Juvenile Court Proceedings There are other court proceedings involving myself, and the other party, and/or cases involving our children. If so, please provide the following information: Name of Court (e.g. Probate, Family, and Juvenile) County State To be filled out by Family Court Staff: Amount rec'd: $ Check Cash Money Order IFP Filed Rev. 1/06 SML Type of MPR filed: Service Option: Personal Service 1st Class Mail Certified Mail MPR #: Service Complete Party/Atty will serve American LegalNet, Inc. SEE INSTRUCTIONS ON BACK OF THIS COVER SHEET www.FormsWorkflow.com Instructions Fill in all of the information in the top box (name through date of birth). You must provide information both about yourself and about the party on the other side of your case. 1. Filing Fee a) Amount of fee: The amount of the filing fee varies depending on what you are filing. If you don't know the amount of the fee, ask the clerk or consult the judiciary website at: www.vermontjudiciary.org. b) Checks: Make checks payable to Vermont Family Court. c) IFP: If you cannot afford the fee, you may ask the Court to waive the fee by filing an IFP (in forma pauperis) application. Ask the clerk for the application or consult the judiciary website at: www.vermontjudiciary.org. 2. Service Fee Service is a way of documenting that the other party has actually received the paperwork. There are several methods of service. The clerk can help you choose which method is best for you. You must pay a fee for service unless the court has found that you are financially unable to pay the filing fee. In that case, the court will pay for service. If you have questions, ask the clerk or consult the judiciary website at: www.vermontjudiciary.org. Case with minor children: If you are filing a case involving minor children or seeking relief related to child support, the court clerk is responsible for serving the summons, complaint, or petition and notice of hearing on the other party at your expense, unless you qualify for a waiver of the fee. Cases without minor children: If you are filing a new case which does not involve minor children or if you are seeking relief not related to child support, you are responsible for serving the other party. Ask the clerk for information about "service of process." If you are represented by an attorney, your attorney may choose to serve all paperwork on the other party. 3. Public Assistance Check the box for Public Assistance if you receive any of the following: Reach-Up; Dr. Dynosaur; Medicaid; Post Secondary Education Stipend (PSE). Do not check the box if you only receive food stamps and/or fuel assistance. 4. Office of Child Support The Office of Child Support Services can help people to choose the best method for collecting child support, prepare court forms, prepare financial affidavits, locate absent parents, and assist persons at a child support hearing before a Magistrate. If you would like their assistance and services; please call: 1-800-786-3214. 5. Other Family/Probate/Juvenile You must list all other court proceedings involving yourself, and the other party or cases involving your children. Rev. 1/06 SML American LegalNet, Inc. www.FormsWorkflow.com