Fillable 700-00301 Verified Petition For Birth Order

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700-00301 Verified Petition For Birth Order

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The 700-00301 Verified Petition For Birth Order form is 2 pages long and contains:

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700-00301 – Verified Petition for Birth Order (07/2018) Page 1 of 2
STATE
OF
VERMONT
SUPERIOR COURT
PROBATE DIVISION
Unit
Docket No.
VERIFIED PETITION FOR BIRTH ORDER
Petition filed: ☐ Pre-Birth ☐ Post-Birth
1. Petitioner A Information
Name: ________________________________________________ Date of Birth: ____________________________
Street Address: _________________________________________ City/State/Zip: ___________________________
Mailing Address (if different from Street Address): ______________________________________________________
City/State/Zip: __________________________________________ Email Address: __________________________
Daytime Phone: _________________________________________ Evening Phone: _________________________
Attorney Name: ________________________________________ Attorney Phone: _________________________
2. Petitioner A is (check all that apply)
☐ The birth parent
☐ Intended parent
☐ Other: state the nature of parental relationship to the child________________________________________
3. Petitioner B Information
Name: ____________________________________________ Date of Birth: ____________________________
Street Address: ____________________________________ City/State/Zip: ___________________________
Mailing Address (if different from Street Address): ____________________________________________________
City/State/Zip: _____________________________________ Email Address: __________________________
Daytime Phone: ___________________________________ Evening Phone: _________________________
Attorney Name: ___________________________________ Attorney Phone: _________________________
4. Petitioner B is (check all that apply)
☐ The birth parent
☐ Intended parent
☐ Other: state the nature of parental relationship to the child___________________________________
5. Child’s Name (if filing after child born)
Name: _________________________________________ Date of Birth: ________________________________
6. Respondent Information
Name: ________________________________________________ Date of Birth: ____________________________
Street Address: _________________________________________ City/State/Zip: ___________________________
Mailing Address (if different from Street Address): ______________________________________________________
City/State/Zip: __________________________________________ Email Address: __________________________
Daytime Phone: _________________________________________ Evening Phone: _________________________
Attorney Name: ________________________________________ Attorney Phone: _________________________
700-00301 – Verified Petition for Birth Order (07/2018) Page 2 of 2
7. Respondent is (check all that apply)
☐ The birth parent
☐ Intended parent
☐ Other: state the nature of parental relationship to the child _________________________
8. Other possible parent, if any (notice will be sent)
Name: ________________________________________________ Date of Birth: ____________________________
Street Address: _________________________________________ City/State/Zip: ___________________________
Mailing Address (if different from Street Address): ______________________________________________________
City/State/Zip: __________________________________________ Email Address: __________________________
Daytime Phone: _________________________________________ Evening Phone: _________________________
Attorney Name: ________________________________________ Attorney Phone: _________________________
9. Other party is (check all that apply)
☐ The birth parent
☐ Intended parent
☐ Other: state the nature of parental relationship to the child ___________________________________
I/We, request that a Birth Order be issued for ____________________________ and __________________________
Parent Name Parent Name
and that Parental Rights and Responsibilities be granted exclusively to them after the child is born. The facts that
support my request are:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Stipulated by: ________________________________________________________________________
☐ Stipulation Attached
_________________________________ ___________________________________________________
Date Signature of Petitioner
_________________________________ ___________________________________________________
Date Signature of Respondent
_________________________________ ___________________________________________________
Date Signature of Other Party
Signed and sworn to before me:
Date Signature of Notary Public Expiration Date
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700-00301 Verified Petition For Birth Order

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Completed 3 July 2020

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