Fillable AFFIDAVIT IN SUPPORT OF REQUEST FOR ORDER AGAINST (Vermont Judiciary)

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AFFIDAVIT IN SUPPORT OF REQUEST FOR ORDER AGAINST (Vermont Judiciary)

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100-00248 - Affidavit for Stalking and Sex Assault Complaint (11/2019) Page 1 of 1
STATE OF VERMONT
SUPERIOR COURT
CIVIL DIVISION
Unit
Docket No.
Plaintiff/Petitioner
Defendant
vs.
AFFIDAVIT IN SUPPORT OF REQUEST FOR ORDER AGAINST STALKING OR SEXUAL
ASSAULT
Pursuant to 12 V.S.A. 5133(a)
In support of my request for a protection order, subject to the penalties for perjury, I state the following
facts to be true to the best of my knowledge and belief about the present situation: (Specifically describe
the facts that support your complaint)
Dated ____________________ _____________________________________
Plaintiff/Petitioner
Subscribed and sworn to before me.
NOTICE!
This affidavit will be served on Defendant with the Complaint for Order Against
Stalking or Sexual Assault.
WARNING:
MAKING FALSE STATEMENTS IN THIS AFFIDAVIT IS A CRIME SUBJECT TO A TERM OF IMPRISONMENT
OR A FINE, OR BOTH AS PROVIDED BY 13 V.S.A. §2904.
Signature of Notary Public Date Expiration Date
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AFFIDAVIT IN SUPPORT OF REQUEST FOR ORDER AGAINST (Vermont Judiciary)

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Completed 30 July 2020

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