COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Form 836 CU Vermont County Index No. Docket Number Family Court : Calendar No. SUMMONS, COMPLAINT FOR CIVIL : UNION DISSOLUTION JUDICIAL SUBPOENA Plaintiff(s) NOTICE OF APPEARANCE AND AFFIDAVIT OF CHILD CUSTODY Plaintiff’s Name -against- : Defendant’s Name : Street Address Street Address Town/City State Zip Code VTown/City . : State Zip Code Defendant(s) : ...................................................... SUMMONS To the above-named Defendant: You are hereby summoned and required to serve upon the Plaintiff at the address listed above an Answer to the THE PEOPLE OF THE STATE OF NEW upon you. attached Complaint that has been served YORK You must also file a copy of your Answer TO with the Court at the following address: Name and Address of the Court GREETINGS: You mustWE COMMAND summons within and excuses beingthe aside, you and each of you attend before answer this YOU, that all business (20) days of laid date of service. , the Honorable at the Court If you fail to answer the Complaint within twenty days, a Default Judgment may be entered against located at County of you and the Court may grant the relief demanded by the plaintiff in the Complaint. in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Under most circumstances, your answer must state as a counterclaim any related claim which you may have against the plaintiff, or you will thereafter be barred from making such claim in any other action. Court Clerk Date Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. COMPLAINT FOR CIVIL UNION DISSOLUTION Witness, Honorable , one of the Justices of the Town/City County State Court in resides in County, day of , 20 1. (a) Plaintiff (b) ___ Plaintiff has resided in Vermont continuously until the present day since 2. (a) Defendant resides in Date (Attorney must sign above and type name below) Town/City County Attorney(s) for (b) ___ Defendant has resided in Vermont continuously until the present day since Date Date 3. Plaintiff and Defendant received a Certificate of civil union on Town/City State at State Office and P.O. Address 4. The following are the biological or adoptive children of said civil union: Name of Child Date of Birth Name of Child Date of Birth Name of Child Date of Birth Form 836 CU 10/00 Name of Child Telephone No.: Name of Child Facsimile No.: E-Mail Address: Name of Child Mobile Tel. No.: Date of Birth Date of Birth Date of Birth American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Calendar No. : JUDICIAL SUBPOENA 5. The parties own the following property singly or jointly: Plaintiff(s) -against- : : : Defendant(s) : ...................................................... 6. The following actions for divorce, annulment, civil union dissolution, abuse prevention or separate support THE PEOPLE OF THE STATE OF NEW YORK have been brought by either party against the other: ____ None, or: TO GREETINGS: ( ___ A certified copy of the complaint and docket entries in the previous action is attached.) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before 7. Defendant has/will have lived separate and apart fromat the the plaintiff for six consecutive months and the resumption the Honorable Court of the County of relationship is not reasonably probable. The parties separated on Date civil union located at in room , on the day of , 20 , at o'clock in the noon, and at any recessed 8. ___or adjourned ___ Defendantand or has been a as a witness in this action on thefrom of the Department of Plaintiff date, to testify is give evidence recipient of public assistance part the VT Social Welfare. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to PLAINTIFF REQUESTS THE FOLLOWING RELIEF: the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. ___ 1. Dissolution of civil union. ___ 2. That the Court award ___ the plaintiff Witness, Honorable the minor children. Court in County, day of ___ the defendant legal rights and responsibilities for , one of the Justices of the ___ 3. That the Court award ___ the plaintiff for the minor children. ___ the defendant physical rights and responsibilities , 20 (Attorney must sign above and type name below) ___ 4. That the Court award ___ the plaintiff ___ the defendant suitable parent/child contact. ___ 5. That the Court award payment of suitable child support money. Attorney(s) for ___ 6. That the Court award ___ the plaintiff ___ the defendant suitable maintenance supplement. ___ 7. That the Court award ___ the plaintiff ___ the defendant P.O. Address suitable maintenance. Office and ___ 8. That the Court award ___ the plaintiff the civil union. ___ the defendant a suitable portion of the property of Telephone No.: Facsimile ___ 9. That the Court award the plaintiff costs and attorney’s fees. No.: E-Mail Address: ___10. Such other relief as is just and equitable. Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com , COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : NOTICE OF APPEARANCE : Index No. Calendar No. I, the Plaintiff in this case, enter my pro se appearance; I will represent myself. Unless I or an attorney : JUDICIAL SUBPOENA Plaintiff(s) notify you otherwise, no attorney will represent me in this case. -against- : All court papers may be mailed to me by first class mail at the address listed above. I understand that it : is my responsibility to notify the Court of any change in my mailing address. I understand that if I send anything to the Court, I must send copies to Defendant or Defendant’s attorney. : I can be reached by telephone at the following numbers. : Defendant(s) ...................................................... Telephone Number (day) Telephone Number (evening) THE PEOPLE OF THE STATE OF NEW YORK TO AFFIDAVIT OF CHILD CUSTODY I. With regard to each child named in the above complaint, the child: (use an additional page if you need more space) GREETINGS: A. now lives: at ___ my address ___ the address listed below: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable in the places listed below within thethe five years: Court at last B. has lived located at County of the (give in the inC. has lived withon the room , the following people during , 20 past, five yearso'clock current address):and at any recessed day of at noon, or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. II A. Have you participated as a party, witness, or in any other capacity in any litigation concerning the custody of the child(ren)Honorable yes** Witness, named above, in Vermont or in any other state? ___ , one of the___ no of the Justices Court in you have information of any custody proceeding concerning the child(ren) named above pending County, day of , 20 B. Do in a court in Vermont or in any other state? ___ yes** ___ no (Attorney must sign above and type name below) C. Do you know of any person not a party to these proceedings who has physical custody of the child(ren) named above or claims to have custody or visitation rights with respect to the child(ren)? ___ yes** ___ no (** If you answered “yes”, please explain on another page) Attorney(s) for Notice: During this proceeding, you must inform the court if you learn of any other custody proceeding concerning the child(ren). Date Signature of Plaintiff Subscribed and sworn to before me: Date Form 836 CU 10/00 Signature of Notary Public Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Expiration Date American LegalNet, Inc. www.USCourtForms.com