Vermont > Statewide > Probate Court
Waiver Of Counsel 135 - Vermont
| Waiver Of Counsel Form. This is a Vermont form and can be used in Probate Court Statewide . |
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Probate Court Form 135 Waiver of Counsel STATE OF VERMONT PROBATE COURT DISTRICT OF _______________________ DOCKET NO. ___________________IN RE THE ADOPTION OF __________________________ WAIVER OF COUNSEL 15A V. S. A. 3 -503(b)(1) I, ____________________________________, have been informed that I am entitled to be represented by an attorney who is not representing adoptiv an e parent or an agency to which the parentschild is being relinquished. I fully understand that these proceedings may result in the TERMINATION OF MY RELATIONSHIP TO MY CHILD. I fully understand myRI GHT TO AN ATTORNEY, and it has been explained to me that anattorney will be appointed to represent me if I want an attorney and cannot afford to hire an attorney at myown expense. However,I DO NOT WISH TO BE REPRESENTED BY AN ATTORNEY, and I hereby waivemy right to be represented by an attorney in this proceedings. Please send all correspondence to me at the address below. Signature : ________________________________ Date: ________________________________ Address: ________________________________ ________________________________ ________________________________ Telephone: Home ( ) _______________________ Work ( ) _______________ Signed in the presence of a Notary Public or other person authorized by the Probate Court. Subscribed and sworn to on this ____________________ day of ___________________, 20_____. Before me, _______________________________________ Notary Public, Judge
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