Form 836 SUMMONS, COMPLAINT FOR DIVORCE, NOTICE OF APPEARANCE, AND AFFIDAVIT OF CHILD CUSTODY Vermont Family Court County Docket Number Defendant's Name Plaintiff's Name Street Address VS - Street Address State Town/City Zip Code Town/City State Zip Code 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 attached Complaint that has been served upon you. You must also file a copy of your Answer with the Court at the following address: Name and Address of the Court . You must answer this summons within twenty (20) days of the date of service; of if served by acknowledgement 60 days from the date the acknowledgement was mailed. If you fail to answer the Complaint within twenty days, a Default Judgment may be entered against you and the Court may grant the relief demanded by the plaintiff in the Complaint. 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 COMPLAINT FOR DIVORCE Town/City County State 1. (a) Plaintiff resides in Date (b) Plaintiff has resided in Vermont continuously until the present day since County Town/City State 2. (a) Defendant resides in Date (b) Defendant has resided in Vermont continuously until the present day since Date Town/City 3. Plaintiff and Defendant were married on State at 4. The following minor children were born of said marriage: Name of Child Date of Birth Name of Child Date of Birth Name of Child Date of Birth Name of Child Date of Birth Name of Child Date of Birth Name of Child Rev. 7/04 SML Date of Birth American LegalNet, Inc. www.FormsWorkflow.com Form 836 page 2 5. The parties own the following property singly or jointly: 6. The following actions for divorce, annulment, abuse prevention or separate support have been brought previously by either party against the other: None, or: ( A certified copy of the complaint and docket entries in the previous action is attached.) 7. Defendant has/will have lived separate and apart from the plaintiff for six consecutive months and the resumption of a marital relationship is not reasonably probable. The parties separated on Date 8. Plaintiff Defendant is or has been a recipient of public assistance from the VT Department of PATH. PLAINTIFF REQUESTS THE FOLLOWING RELIEF: 1. Divorce from the bonds of matrimony. the defendant legal rights and responsibilities for the 2. That the Court award the plaintiff minor children. 3. That the Court award the plaintiff the defendant physical rights and responsibilities for the minor children. the defendant suitable parent/child contact. 4. That the Court award the plaintiff 5. That the Court award payment of suitable child support and medical support. the defendant suitable maintenance supplement. the plaintiff 6. That the Court award the defendant suitable spousal maintenance. 7. That the Court award the plaintiff 8. That the Court award the plaintiff the defendant a suitable portion of the property of the marriage. 9. That the Court award the plaintiff costs and attorney's fees. 10. Such other relief as is just and equitable. Rev. 7/04 SML American LegalNet, Inc. www.FormsWorkflow.com Form 836 page 3 NOTICE OF APPEARANCE I, the Plaintiff in this case, enter my pro se appearance; I will represent myself. Unless I or an attorney notify you otherwise, no attorney will represent me in this case. 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. Telephone Number (day) Telephone Number (evening) AFFIDAVIT OF CHILD CUSTODY 1. With regard to each child named in the above complaint, the child: (use an additional page if you need more space) A. now lives: at my address the address listed below: B. has lived in the places listed below within the last five years: C. has lived with the following people during the past five years (give their current address): 2. A. Have you participated as a party, witness, or in any other capacity in any litigation concerning the yes** custody of the child/ren named above, in Vermont or in any other state? no B. Do you have information of any custody proceeding concerning the child/ren named above pending in yes** a court in Vermont or in any other state? no 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? no yes** (** If you answered ''yes", please explain on another page) 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 Rev. 7/04 SML Signature or Notary Public Expiration Date American LegalNet, Inc. www.FormsWorkflow.com