Probate Court Form 188 Petition for Correction of Death Record STATE OF VERMONT PROBATE COURTDISTRICT OF _______________________ IN RE ____________________ PETITION FOR CORRECTION OF DEATH RECORD TO THE HONORABLE PROBATE COURT FOR THE DISTRICT AFORESAID: Comes ___________________________________ of ___________________________ in theCounty of _________________________ and the State of Vermont, and respectfully represents that ________________________________________________ a resident of __________________________ (Name of Decedent) County of ______________________________ and State of Vermont, died on the _____________ day of_____________________________, 20 _____. That the record of - His - Her - death appears in the records of the Clerks office of the - Town - Cityof ___________________________ County of ___________________________ and State of Vermont, (a copy of which is hereto attached) and That said record contains the following errors and omissions, viz:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _____ That said erroneous facts and omissions in said record should correctly appear as follows, to wit:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _____________ That your petitioner prays that said Court, after due notice and hearing, find the facts with respectto the Record of Death of decedent, issue a decree setting forth the facts found and fill our a corrected DeathCertificate in the usual form, and file such certificate with the Clerk of the Town - City - of ________________________________, County of ____________________________ and State of Vermont.Dated: __________________________ Signed _____________________________ Print Name: _________________________ Address: ____________________________ ____________________________________ Telephone: (____) ____________________