COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Probate .Court Form No. 200 .... .. .. : Petition for Correction of Birth Certificate Index No. STATE OF VERMONT DISTRICT OF _______________________ Plaintiff(s) : Calendar No. PROBATE COURT -againstIN RE __________________________ : : JUDICIAL SUBPOENA : PETITION FOR CORRECTION OF BIRTH CERTIFICATE : Defendant(s) : . . . . . . . . TO . . . . .HONORABLE .PROBATE. COURT FOR .THE. DISTRICT AFORESAID: . . . THE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Comes ________________________________________ of ____________________________ in the County of ________________and the State of Vermont, and respectfully represents that they were born in the THE PEOPLE OF THE STATE OF NEW YORK Town - City of __________________________ in the County of ____________________ and the State of Vermont, on the _______________ day of ____________________ 20_____. TO That the record of their birth appears in the records of the Clerk’s Office of the Town - City of ______________________________ County of __________________________ and the State of Vermont, (a copy of which is hereto attached) and GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before That said record contains the following errors and omissions, viz: , the Honorable at the Court located at County of ____________________________________________________________________________________ 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 ____________________________________________________________________________________ ____________________________________________________________________________________ _____________________________________________________________________________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to That said behalf this subpoena was issued for a maximum penalty of $50 and follows, to sustained as a the party on whose erroneous facts and omission in said record should correctly appear asall damages wit: result of your failure to comply. ____________________________________________________________________________________ ____________________________________________________________________________________ Witness, Honorable , one of the Justices of the ____________________________________________________________________________________ Court in County, day of , 20 ____________________________________________________________________________________ _____________________________________________________________________________________ (Attorney must and hearing, find the facts WHEREFORE, your petitioner prays that said court, after due noticesign above and type name below)with respect to the Record of Birth of your petitioner, issue a decree setting forth the facts found and fill out a corrected Certificate of Birth in the usual form, and file such certificate with the Clerk of the Town - City of ________________________________, County of _______________________and State of Vermont, Attorney(s) for Dated: __________________________ Signed _____________________________ Office and P.O. Address Print Name: _________________________ Address: ____________________________ ____________________________________ Telephone No.: Telephone: (____) ____________________ Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com