Form 809 SUPERIOR COURT ______________ Unit Plaintiff Name STATE OF VERMONT FAMILY DIVISION Docket No.______________ Defendant DOB Name DOB v. NOTICE OF APPEARANCE and INTENT TO REPRESENT MYSELF I intend to represent myself and hereby enter my appearance with the court. No attorney will represent me in this case unless an attorney or I notify the court otherwise. I understand that IT IS MY RESPONSIBILITY to: 1. Notify the Court in writing if I change my address or phone number; and 2. Send copies of any papers I file with the court to the other party in this case. All court papers may be mailed to me by first class mail at the address listed below. My Street Address My Mailing Address (if different): Town/City Phone Number (day) State Zip Town/City Phone Number (day) State Zip ( ) ( ) E Mail Address PETITION FOR WAGE WITHHOLDING Pursuant to 15 V.S.A. §782 1. I am the Plaintiff Defendant Plaintiff Office of Child Support Defendant 2. The other party is the 3. On , the other party was ordered to pay: $__________ per _____________ in Child Support $__________ per _____________ in Maintenance Supplement $__________ per _____________ in Spousal Maintenance (Alimony) 4. The order was issued by: this court another court___________________________________________________ Name and address of Court 5. The other party has failed to pay to make payments as ordered by the Court. American LegalNet, Inc. www.FormsWorkFlow.com 6. The other party owes the following amounts: $________________ in child support owed to me. $________________ in child support maintenance supplement owed to me. $________________ in spousal maintenance owed to me. $________________ in child support owed to the State of Vermont. 7. Some or all of these amounts are 7 days overdue. 8. A Case Accounting Affidavit from OCS: Is attached. Is not attached. 9. The other party's employment: The name of the other party's employer is: ______________________________. I do not know the name of the other party's employer The other party is self-employed. The other party is unemployed REQUEST TO THE COURT I request that the Court: Enter a Judgment against the the other party for all unpaid support. Order Wage Withholding from the the other party's wages in the following amounts: $____________ per month for current support; $____________ per month towards the arrearage balance; Order that such amounts be paid directly to the Office of Child Support on my behalf. Grant any other relief this Court determines is appropriate. I hereby swear or affirm that the information above is true to the best of my knowledge and belief. Signature of Plaintiff Date Signed and sworn to before me: Date Signature of Notary Public Expiration Date AT HEARING THE OTHER PARTY MAY OBJECT TO WAGE-WITHHOLDING ON THE BASIS OF AN ERROR IN THE AMOUNT OF CURRENT SUPPORT OR ARREARAGES OR AN ERROR IN IDENTITY. American LegalNet, Inc. www.FormsWorkFlow.com