400-00156 – Confidential Notification for Relief from Abuse (09/2017) Page 1 of 1
CONFIDENTIAL
Litigant's Address for Notification
Name: _________________________________________________________________________________
Vermont Family Court Rules say that parties filing documents in Relief From Abuse cases must give the
Court an address and telephone number. The address and telephone number you give are for the Court
to contact you about your case. Please complete the information below:
For the Court to contact me about my case, I can be reached at:
Mailing Address: __________________________________________________________________
City, State Zip: __________________________________________________________________
Home/Cell Phone: _________________________ Work Phone: _________________________
The address & telephone number(s) you have given in this case cannot be given to any person without your
permission. Do you consent to the release of this information?
☐ Yes ☐ No
_______________________________________ ____________________________________
Date Signature
Important information: The rule that requires the Court to keep your address and telephone number
confidential applies ONLY to Relief From Abuse cases.
If you have other cases in Court, and you want the Court to keep your address
and telephone number(s) confidential in those cases, you must file a written
request in each. Your request will be given to the Judge. It is up to the Judge to
decide.
