Form 819PARENTAGE ORDERFatheris the father of the following minor child/ren born ofMother Date of BirthName of ChildName of Child Date of BirthName of Child Name of Child Date of BirthName of Child Name of Child DateOffice of Child Support RepresentativeThe above is stipulated to by the parties. DateSignature of MotherDateSignature of FatherApproved as to Form. DateSignature of Mother's Attorney Signature of Father's AttorneyDate DateMagistrate/ Presiding JudgeIt is so ORDERED. Assistant Judge DateDateAssistant JudgeACCEPTANCE OF SERVICE.I have received a copy of this Order and I waive all other service. DateDateFatherMotherRev. 7/10 SML-Date of BirthDate of BirthDate of Birth STATE OF VERMONTSUPERIOR COURT FAMILY DIVISION Unit Docket No. v. Defendant's Name DOB / / Plaintiff's Name DOB / / American LegalNet, Inc. www.FormsWorkFlow.com