Vermont > Statewide > Family Court
Affidavit Of Child Custody 834 - Vermont
| Affidavit Of Child Custody Form. This is a Vermont form and can be used in Family Court Statewide . |
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Form 834 STATE OF VERMONT SUPERIOR COURT Unit Plaintiff Name Name FAMILY DIVISION Docket No. Defendant v. Uniform Child Custody Jurisdiction Act AFFIDAVIT of CHILD CUSTODY I, ________________________________, hereby state that the following facts (Print Name) are true to the best of my knowledge and belief: 1. I am the Plaintiff in this case. Defendant in this case. 2. I am the Biological or adoptive mother; Biological or adoptive father; Other:_________________________________ For the child(ren) who is/are the subject(s) of this proceeding. 3. During the last five years, the children have lived at the following addresses with the following household members: (Begin with the child's residence just before this court case started and list all addresses for the past five years.) Address Dates Names of all persons residing in the Include street, city and From when to household with the child state when 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. 9/10 SML American LegalNet, Inc. www.FormsWorkFlow.com (A) 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: Please answer the following questions by checking the box if the statement is true. If your answer to any of the questions is "yes", please explain your answer on an additional page. (i) I have participated as a party, witness, or in some other way in a court case about the custody of this child/these children in Vermont or another state. Yes No I have information about a custody case concerning this child/these children that is now pending in a Vermont court or a court in another state. Yes No I have knowledge about a person who is not a party to this case who has physical custody of this child/these children or who claims to have custody or visitation rights to this child/these children. Yes No (B) (ii) (iii) : I hereby swear or affirm that the information above is true to the best of my knowledge and belief. Date Signature Please Print Name Signed and sworn to before me: Date Signature of Notary Public Expiration Date American LegalNet, Inc. www.FormsWorkFlow.com
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