400-00153 226 Motion to Modify/Extend/Vacate RFA Order (01/2019)Page 1 of 1 Plaintiff DOB Defendant DOB MOTION TO MODIFY/EXTEND/VACATE Relief from Abuse Order An Order for relief from abuse was entered in the above case: date The Plaintiff Defendant requests that this Order of the Court be: Modified as follows:Extended until date Vacated.Affidavit in Support of Request In support of this request, subject to the penalties for perjury, I state the following facts to be true to the best of my knowledge and belief. Specifically describe the facts that support your request. I swear or affirm that the facts set forth in this petition are true and correct to the best of my knowledge and belief. Date: Signature: Printed Signature: Signed and sworn to before me: Date: Expiration Date: Signature of Notary: NOTICE This affidavit will be served on opposing party with the motion to modify/extend/vacate relief from abuse. WARNING: MAKING FALSE STATEMENTS IN THIS AFFIDAVIT IS A CRIME SUBJECT TO A TERM OF IMPRISONMENT OR A FINE, OR BOTH AS PROVIDED BY 13 V.S.A. 2472904. STATE OF VERMONT SUPERIOR COURT FAMILY DIVISION Unit Docket No. American LegalNet, Inc. www.FormsWorkFlow.com