Fillable 700-00005 Form PE 34D

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700-00005 Form PE 34D

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700-00005 – Notice of Appeal (07/2019) Page 1 of 1
STATE
OF
VERMONT
SUPERIOR COURT
PROBATE DIVISION
Unit
Docket No.
NOTICE OF APPEAL TO PROBATE DIVISION
PURSUANT TO 18 V.S.A. §5202a(c)
Notice is given that _________________________________, appeals to the Probate Division of the
(name of party appealing)
Superior Court from the State’s Registrar’s decision entered on ___________, 20 __________ to deny
application for a correction, completion, or amendment of a ☐ birth certificate or ☐ death certificate.
(please check one)
Attached is a copy of the application to the State Registrar and a Certified copy of the denial order.
Date: _________________ Signature: _______________________________________
Printed Name: _______________________________________
Mailing Address: _______________________________________
_______________________________________
Email Address: _______________________________________
Attorney for: _______________________________________
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700-00005 Form PE 34D

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Completed 3 July 2020

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