400 - 00836 Children Complaint for Divorce / Legal Separation / Dissolution with Children (01/2018 ) Page 1 of 6 STATE OF VERMONT SUPERIOR COURT FAMILY DIVISION Unit Docket No. Plaintiff Name Defendant Name v . Plaintiff Information: Name: Date of Birth: Street Address: City/State/Zip: Mailing Address (if different from Street Address) : City/State/Zip: Email Address: Daytime Phone: Even ing Phone: A ttorney Name: Attorney Phone: Defendant Information: Name: Date of Birth: Street Address: City/State/Zip: Mailing Address (if different from Street Address) : City/State/Zip: Email Address: Daytime Phone: Even ing Phone: A ttorney Name: Attorney Phone: SUMMONS THIS SUMMONS IS DIRECTED TO: Name of Defendant 1. PLAINTIFF IS SEEKING A Name of Plaintiff DIVORCE LEGAL SEPARATION CIVIL UNION DISSOLUTION The C omplaint begins on the next page. Do not throw these papers away. They are official papers that affect your rights. 2. TO PROTECT YOUR RIGHTS, YOU SHOULD REPLY WITHIN 2 1 DAYS. Your written response is called an Answer. You can get an official court form for an Answer to a Divorce Complaint at any Vermont F amily C ourt or on the Judiciary web site at http://www.vermontjudiciary.org. 3. YOU MUST RESPOND TO EACH CLAIM. In your Answer you must state whether you agree or disagree with each paragraph of the C omplaint. If you believe the Plaintiff should not be given everything asked for in th e C omplaint, you should say so in your Answer. 4. IF YOU DO NOT FILE AN ANSWER OR FILE AN APPEARANCE, THE COURT IS NOT REQUIRED TO NOTIFY YOU OF HEARINGS. If you do not attend the court hearings, the Plaintiff may receive everything requested in the C omplaint. You will not get a chance to tell your side of the story. American LegalNet, Inc. www.FormsWorkFlow.com 400 - 00836 Children Complaint for Divorce / Legal Separation / Dissolution with Children (01/2018 ) Page 2 of 6 5. YOU MUST GIVE OR SEND A COPY OF YOUR ANSWER TO THE PLAINTIFF. If the Plaintiff has an attorney, you mu st give or send a copy of your A nswer to the P attorney. 6. YOU MUST GIVE OR SEND YOUR ORIGINAL ANSWER TO THE COURT at this address: 7. LEGAL ASSISTANCE: You may wish to get help from a lawyer. Even if you cannot get legal help, you must still give the C ourt a written Answer to protect your rights. Dated Signature of Court Clerk American LegalNet, Inc. www.FormsWorkFlow.com 400 - 00836 Children Complaint for Divorce / Legal Separation / Dissolution with Children (01/2018 ) Page 3 of 6 COMPLAINT FOR DIVORCE /LEGAL SEPARATION/DISSOLUTION FACTS The Plaintiff states that the following facts are true: 1. Residence: (A) I am now a resident of , . County State I have resided in Vermont for 6 full months. (B) Defendant is now a resident of , . County State Defendant has resided in Vermont for 6 full months. 2. Marriage: We were married at , City State on and are still married. M onth/ D ate/ Y ear Civil Union: Our c ivil union took place at , City State on and it has never been dissolved . M onth/ D ate / Y ear 3. Grounds for Divorce /Legal Separation/Dissolution : The reason I am asking for a D ivorce L egal S eparation Dissolution Is that: Six Month Separation: We have or will have lived separate and apart for more than six (6) consecutive months and it is not reasonably probable that we can resume our relationship. The Defendant and I separated on : . M onth/ D ate / Y ear this field is required Other: (Please explain) 4. Minor Children of the P arties: We have children of our marriage who are either younger than 18 years old, or are 18 years old and still in high school. Include born or adopted children. Name of Child Date of Birth American LegalNet, Inc. www.FormsWorkFlow.com 400 - 00836 Children Complaint for Divorce / Legal Separation / Dissolution with Children (01/2018 ) Page 4 of 6 5. UCCJ E A Jurisdiction: Informa tion required under 15 V.S.A. 247 10 71 (A) During the last five years the children listed above have lived at the following addresses with the following household members: just before this court case started and list all addresses for the past five years.) Address Dates Name of All Persons Living ( Include street/city/state ) (From when to when) in the Household with the Child Use an additional page if you need more space. If children have lived at different addresses from each other please indicate the addresses for each child. (B) If the current address of any household member listed in the last column is different from the address listed above, please provide a current address for that person in the box or on another page. (C) Please check the box below if the statement next to it is true. For each box you check, please explain your answer on another page. I have participated as a party, witness, or in some other way in a court case about the custody of this child or these children in Vermont or another state. I have information about a case concerning this child or these children that is now pending in a Vermont court or a court in another state. I have knowledge about a person who is not a party to this case who has physical custody of this child or these children or who claims to have custody of or visitation rights to this child or these children. 6. Property, Assets and Debts: I have listed all of the property, assets and debts that my spouse and I own either together or separately that are known to me, in the Financial Affidavit that I am filing with this Complaint (form 400 - 00813 B ) . 7. Public Assistance: I receive assistance from the Division of Economic Services . The Defendant receives public assistance from the Division of Economic Services. American LegalNet, Inc. www.FormsWorkFlow.com 400 - 00836 Children Complaint for Divorce / Legal Separation / Dissolution with Children (01/2018 ) Page 5 of 6 8. Earlier actions for divorce, legal separation, dissolution , annulment : I have not filed for divorce, legal separation , dissolution or annulment in any court against the Defendant, as far as I know, the Defendant has not filed for divorce, legal separation , dissolution or annulment against me. I have filed OR the Defendant has filed for divorce, legal separation , dissolution or annulment before the date of the filing of this pet ition. ( If you check this box, you must fill in the information below. Use an additional page if necessary.) Type of Action Who Filed Where Filed Year Filed (Court, County, State) Please attach a copy of any Court Order issued in a case listed above. 9. Relief from abuse or protective order proceedings: I have not filed a complaint for relief from abuse or a request for a protective order against the Defendant AND, as far as I know, the Defendant has not filed such an action against me. I have filed a complaint for relief from abuse or a request for a protective order against the Defendant OR the Defendant has filed a complaint for relief from abuse or a request for a protective order against me. ( If you check this box, you must complete the information below. Use an additional page if necessary.) Type of Action Who Filed Where Filed Year Filed (Court, County, State) Please attach a copy of any Court Order issued in a case listed above. 10. Military Service: The Defendant is in the military service. The Defendant is not in the military service. I am in the military service. I am not in the military service. REQUEST FOR RELIEF 1. I ask that the Family Court grant me: ( check each box that applies ) Decree of D ivorce Decree of L egal S eparation Decree of Dissolution 2. Parental Right and Responsibilities Legal parental rights and responsibilities: Shared jointly Given solely to: Myself Defendant Physical parental rights and responsibilities Shared jointly Given solely to: Myself Defendant 3. Parent Child Contact for : Myself Defendant 4. Child support, medical support and/or maintenance supplement. American LegalNet, Inc. www.FormsWorkFlow.com 400 - 00836 Children Complaint for Divorce / Legal Separation / Dissolution with Children (01/2018 ) Page 6 of 6 5. Division of Property (divide our property, assets and debts). 6. Spousal Maintenance (Alimony). 7. Court costs. 8. Attorney fees. 9. Name change: I would like to resum