Vermont > Statewide > Family Court
Affidavit In Support Of Complaint 151 - Vermont
| Affidavit In Support Of Complaint Form. This is a Vermont form and can be used in Family Court Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
Form 151 Affidavit: Relief From Abuse SUPERIOR COURT Plaintiffs Name STATE OF VERMONT Docket No. DOB / / V. Unit Defendant's Name FAMILY DIVISION DOB / / Defendant's Street Address City, State, Zip AFFIDAVIT IN SUPPORT OF COMPLAINT In support of the claims made in my complaint and subject to the penalties for perjury, I state the following facts to be true to the best of my knowledge and belief. 1. The most recent incident that causes me to ask for an order happened on or about Town, State Name of person Date Time / / at AM PM in when (Describe what happened below. Be specific: What was the act or threat of violence? Where did it happen? Who else was there? Was a weapon involved? Were you or anyone else injured? What were the injuries?) did the following to me and/or the minor children: Attach a separate sheet if necessary 2. Is the incident described above the most serious incident involving the defendant? If your answer is No, please fill in the following information: Yes No Time The most serious incident that causes me to ask for an order happened on Town, State in Date / / (Describe what happened below. Please be specific: What was the act or threat of violence? Where did it happen? Who else was there? Was a weapon involved? Were you or anyone else injured? What were the injuries?) at Attach a separate sheet if necessary 3. Other past incidents of serious violence or threats that support my request for an Order include: (Be specific. For each incident, state: When and where it happened, who else was there, and details about any injuries resulting or weapons used.) American LegalNet, Inc. www.FormsWorkFlow.com Attach a separate sheet if necessary 4. Do you feel that you are in danger of further abuse from the defendant? Yes No 5. Is there an existing order or a pending court proceeding involving you, the Defendant and/or the child/ren named in the complaint? Yes No If yes, please fill in the information requested below: Type of Proceeding Name of Case Name of Court And State Docket Number And Date Filed Divorce/Separation Civil Union Dissolution Parentage Relief From Abuse Protection Order Criminal Guardianship Probate Juvenile I hereby swear or affirm that the information above is true to the best of my knowledge and belief. Signature of Plaintiff Printed Name Date / / Signed and sworn before me: Date Signature of Notary Public Expiration Date / / NOTICE: This Affidavit will be served on Defendant with your Complaint. WARNING MAKING FALSE STATEMENTS IN THIS AFFIDAVIT IS A CRIME SUBJECT TO A TERM OF IMPRISONMENT OR A FINE, OR BOTH AS PROVIDED BY 13 V.S.A. ยง2904. American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
