400-00854 Confidential Notification for Abuse_Neglect_Exploitation (09/2017) Page 1 of 1
STATE OF VERMONT
SUPERIOR COURT
FAMILY DIVISION
Unit
Docket No.
Plaintiff DOB Defendant DOB
V.
CONFIDENTIAL NOTIFICATION FOR ABUSE/NEGLECT/EXPLOITATION
Address for Notification
I am the Plaintiff
Interested Person
Vermont Family Court Rules say that parties filing documents in Relief from Abuse/Neglect/Exploitation 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:
Name: ______________________________________________________________________________________
Address: ____________________________________________________________________________________
City/State/Zip: _______________________________________________________________________________
Phone Number(s): _________________________________________________
The address & phone 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
Important Information
The Rule that requires the Court to keep your address and phone number(s) confidential applies ONLY
to Relief from Abuse/Neglect/Exploitation cases. If you have other cases in Court, and you want the
Court to keep your address and phone number(s) confidential in those cases, you must file a separate
written request in each. Your request will be given to the judge. It is up to the judge to decide.
Dated
_____________________________ ___________________________________
Signature