Petition For Issuance Of Order Confirming Gender Reassignment {700-00207} | Pdf Fpdf Docx | Vermont

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Petition For Issuance Of Order Confirming Gender Reassignment {700-00207} | Pdf Fpdf Docx | Vermont

Petition For Issuance Of Order Confirming Gender Reassignment {700-00207}

This is a Vermont form that can be used for Probate Court within Statewide.

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700 - 0020 7 Petition for Issuance of Order Confirming Gender Reassignment (12/2015) Page 1 of 1 STATE OF VERMONT SUPERIOR COURT PROBATE DIVISION Unit Docket No. In re: Name on Certificate PETITION FOR ISSUANCE OF ORDER CONFIRMING GENDER REASSIGNMENT I am seeking Court approval for the issuance of an order confirming gender reassignment pursuant to 18 V.S.A. 2475112 so that I can obtain a new birth certificate. In support of my request, I state the following under oath: 1) Information About the Myself: a. Date of Birth: Month Day Year b. Location of Birth: Town/City of Birth County VT c. The birth record is on file in the town/city named above: Yes No d. Sex as stated on the original birth certificate: Male Female e. Sex after completion of surgical, hormonal or other treatment appropriate for the purpose of gender transition: Male Female 2) I have completed gender reassignment through the use of hormonal, surgical or other treatment for the purpose of gender transition and I seek a new birth certificate confirming that gender rea ssignment has occurred. I have attached an affidavit from my licensed physician confirming the facts affirmed herein I therefore request that the Cour t issue a Decree direct ing the Supervisor of the State of Vermont Vital Records Registration to prepare and file a new certificate of birth with the Clerk of the Town/City of birth at , Vermont. Attached are: Filing fee Certified copy of original Birth Certificate Affidavit of Physician in Support of Petition for Issuance of New Birth Certific ate - 700 - 00207AP Date Signature of Petitioner Printed Name Signed and sworn to before me: Date Signature of Notary Public Expiration Date American LegalNet, Inc. www.FormsWorkFlow.com

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