Fillable COMPLAINT FOR ORDER AGAINST STALKING (Vermont Judiciary)

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COMPLAINT FOR ORDER AGAINST STALKING (Vermont Judiciary)

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100-00247S - Complaint for Order Against St
alking (11/2018)
Page 1 of 1
STATE OF VERMONT
SUPERIOR COURT
CIVIL DIVISION
Unit
Docket No.
Plaintiff
Defendant
vs.
COMPLAINT FOR ORDER AGAINST STALKING
Plaintiff’s Information:
Name: __________________________________________ Date of Birth: _______________________
Name(s) of minor child(ren): _____________________ _______________________
_____________________ _______________________
Defendant’s Information:
Name: __________________________________________ Date of Birth: _______________________
Address: ______________________________________________________________________________
Relationship of the Parties:
☐ Married to each other ☐ Live in same residence (current or past)
☐ Divorced from each other ☐ Sexual relationship (current or past)
☐ Dating each other (current or past)
☐ Other (describe relationship) ___________________________________________________________
☐ Family members (describe relationship) __________________________________________________
Other Civil/Probate/Juvenile/Criminal Court Proceedings or Orders Involving These Parties:
Proceeding: ☐ Pending Order ☐ Existing Order
Name of Court: County: _______________ State: ______ Attorney: __________________________
I. STALKING
☐ On more than one occasion, on or about __________________ and ___________________, the
Defendant purposefully did one or more of the following to: ☐ Plaintiff ☐ Plaintiff’s child(ren):
☐ followed, monitored, or surveilled ☐ threatened or made threats ☐ interfered with property
II. REQUEST FOR RELIEF
The Plaintiff requests the Court:
☐ Order the Defendant to stay away from ________________________________________________
☐ Other: ___________________________________________________________________________
___________________________________________________________________________
☐ I am asking for an emergency order before the Defendant is notified and a hearing is held because:
_________________________________________________________________________________
_________________________________________________________________________________
The facts to support this request for protection order can be found on Plaintiff’s accompanying affidavit.
Dated
_____________________________ ___________________________________
Signature of Plaintiff/Attorney
Chittenden
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COMPLAINT FOR ORDER AGAINST STALKING (Vermont Judiciary)

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Completed 30 July 2020

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