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Statement Of Putative Father And Waiver Of Counsel Form. This is a Vermont form and can be use in Probate Court Statewide.
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Tags: Statement Of Putative Father And Waiver Of Counsel, 135A, Vermont Statewide, Probate Court
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. .Probate .Court Form No. 135A
.... .. ..
:
Statement of Putative Father &
Waiver of Counsel
( Page 1of 2 )
Index No.
STATE OF VERMONT
DISTRICT OF _______________________Plaintiff(s)
:
Calendar No.
PROBATE COURT
:DOCKET NO. _____________
JUDICIAL SUBPOENA
-againstIN RE: ADOPTION OF __________________
:
:
STATEMENT OF PUTATIVE FATHER
:
Pursuant to 15A V. S. A. 2-402 (a)(3)
and
Defendant(s)
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WAIVER. OF COUNSEL
........ ............
Pursuant to 15A V. S. A. 3-503 (a)(1)
THE PEOPLE OF THE STATE OF NEW YORK
I, _________________________________, of __________________________________,
Name
City and State
TO
hereby acknowledge that I have been named as the biological father of
_____________________________________, born _________________________________
Child’s Name
Date
GREETINGS:
in ___________________________________, I hereby give notice to all interested parties as follows:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
City and State
,
the Honorable one )
at the
Court
(Please check
located at
County of
in room ________ on theI deny that I am the biological father of this child and have no further interest in any
,
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
pending or proposed adoption proceedings concerning this child.
________
I admit that I am the biological father of this child, but I disclaim any interest in this
child and waive further notice of any pending or proposed adoption proceedings
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
concerning this child
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.
________
I admit that I am the biological father of this child and object to any pending or
proposed adoption. I wish to receive notice of all further adoption proceedings
Witness, Honorable
, one of the Justices of the
concerning this child.
Court in
County,
day of
, 20
I will _____ I will not _____ (please check one) provide birth parent information to the court. This
information may be provided to the child when he or she attains the age of majority.
(Attorney must sign above and type name below)
I hereby acknowledge that this notice is irrevocable and may be admitted into evidence in any
adoption proceeding concerning __________________________.
Minor Child’s Name
Attorney(s) for
I understand that I am entitled to be represented by an attorney who is not representing an adoptive
parent or an agency to which the parent’s child is being relinquished.
I understand that these proceedings may result in the TERMINATION OF MY RELATIONSHIP
Office and P.O. Address
TO MY CHILD.
I understand that an attorney will be appointed to represent me if I want an attorney and cannot afford
Telephone No.:
to hire an attorney at my own expense.
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. .Probate .Court Form No. 135A
.... .. ..
:
Statement of Putative Father &
Waiver of Counsel
( Page 2 of 2 )
:
Index No.
Calendar No.
:
I DO NOT WISH TO BE REPRESENTED BY AN ATTORNEY, and I hereby waive my right to
JUDICIAL SUBPOENA
Plaintiff(s)
be represented by an attorney in these proceedings.
-against:
Please send all correspondence to me at the address below:
:
________________________________________
:
Signature
Defendant(s)
:
. . . . . . . . . . . . . . .________________________________________
.......................................
Print Name
________________________________________
THE PEOPLE OF THE Name and NumberYORK
Street STATE OF NEW
TO
GREETINGS:
_______________________________________
City, State and Zip Code
_______________________________________
Telephone Number (Home)
(Work)
WE COMMAND YOU, that all businessor other person authorized by the Probate Court. attend before
Signed in the presence of Notary Public and excuses being laid aside, you and each of you
,
the Honorable
at the
Court
County ofSubscribed and sworn tolocated at day of _______________ 20_____, Before me,
this _____
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
___________________________________
Notary Public
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.
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
