400-00836NR Complaint for Non-Resident Divorce No Children (01/2018) Page 1 of 5
STATE OF VERMONT
SUPERIOR COURT
FAMILY DIVISION
Unit
Docket No.
Plaintiff Name
Defendant Name
v.
Plaintiff 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: _______________________
Defendant 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: _______________________
SUMMONS
THIS SUMMONS IS DIRECTED TO: _____________________________________________________
Name of
Defendant
1. PLAINTIFF _________________________________________________ IS SEEKING A
Name of Plaintiff
DIVORCE CIVIL UNION DISSOLUTION
The Plaintiff’s Complaint begins on the next page. Do not throw these papers away. They are
official papers that affect your rights.
2. TO PROTECT YOUR RIGHTS, YOU SHOULD REPLY WITHIN 21 DAYS. Your written response is
called an Answer. You can get an official court form for an Answer to a Divorce Complaint at
any Vermont Family Court or on the Judiciary web site at http://www.vermontjudiciary.org.
3. YOU MUST RESPOND TO EACH CLAIM. In your Answer you must state whether you agree or
disagree with each paragraph of the Complaint. If you believe the Plaintiff should not be
given everything asked for in the Complaint, you should say so in your Answer.
4. IF YOU DO NOT FILE AN ANSWER OR FILE AN APPEARANCE, THE COURT IS NOT REQUIRED TO
NOTIFY YOU OF HEARINGS. If you do not attend the court hearings, the Plaintiff may receive
everything requested in the Complaint. You will not get a chance to tell your side of the story.
400-00836NR Complaint for Non-Resident Divorce No Children (01/2018) Page 2 of 5
5. YOU MUST GIVE OR SEND A COPY OF YOUR ANSWER TO THE PLAINTIFF. If the Plaintiff has an
attorney, you must give or send a copy of your answer to the plaintiff's attorney.
6. YOU MUST GIVE OR SEND YOUR ORIGINAL ANSWER TO THE COURT at this address:
7. LEGAL ASSISTANCE: You may wish to get help from a lawyer. Even if you cannot get legal
help, you must still give the Court a written Answer to protect your rights.
Dated
_____________________________ ___________________________________
Signature of Court Clerk
400-00836NR Complaint for Non-Resident Divorce No Children (01/2018) Page 3 of 5
COMPLAINT FOR DIVORCE/DISSOLUTION
FACTS
The Plaintiff states that the following facts are true:
1. Residence:
(A) I am now a resident of , .
County State
Upon information and belief, the state where I reside will not recognize our Vermont
marriage/civil union for purposes of divorce/dissolution.
(B) Defendant is now a resident of _, .
County State
Upon information and belief, the state where I reside will not recognize our Vermont
marriage/civil union for purposes of divorce/dissolution.
2. Marriage:
We were married in Vermont in ____________________________________, _____________
City State
on _______________________________
and are still married.
Month/Date/Year
Civil Union:
Our civil union took place at , ____________
City State
on
and it has never been dissolved.
3. Grounds for Divorce/Dissolution: The reason I am asking for a
Divorce Dissolution
Is that:
Six Month Separation: We have or will have lived separate and apart for more than six (6)
consecutive months and it is not reasonably probable that we can resume our relationship.
The Defendant and I separated on: _____________________________.
Month/Date/Year this field is required
Other:
(Please explain)
4. Children of the Marriage/Civil Union: There are no minor children of the marriage/civil union.
5. Property, Assets and Debts: The Defendant and I have reached a complete agreement
(stipulation) with respect to all matters related to our divorce including the division of our
personal property, assets and debts, the allocation of any real estate we may own, and spousal
maintenance (alimony). A signed written agreement (stipulation) is attached to this Complaint.
6. Public Assistance:
I receive assistance from the Division of Economic Services.
The Defendant receives public assistance from the Division of Economic Services.
400-00836NR Complaint for Non-Resident Divorce No Children (01/2018) Page 4 of 5
7. Earlier actions for divorce, legal separation, dissolution, annulment:
I have not filed for divorce, legal separation, dissolution or annulment in any court against
the Defendant, as far as I know, the Defendant has not filed for divorce, legal separation,
dissolution or annulment against me.
I have filed OR the Defendant has filed for divorce, legal separation, dissolution or
annulment before the date of the filing of this petition. (If you check this box, you must
complete the information below. Use an additional page if necessary.)
Type of Action Who Filed Where Filed Year Filed
(Court, County, State)
________________ ______________ _____________________ __________
________________ ______________ _____________________ __________
________________ ______________ _____________________ __________
Please attach a copy of any Court Order issued in a case listed above.
8. Relief from abuse or protective order proceedings:
I have not filed a complaint for relief from abuse or a request for a protective order
against the Defendant AND, as far as I know, the Defendant has not filed such an action
against me.
I have filed a complaint for relief from abuse or a request for a protective order against
the Defendant OR the Defendant has filed a complaint for relief from abuse or a request
for a protective order against me. (If you check this box, you must complete the
information below. Use an additional page if necessary.)
Type of Action Who Filed Where Filed Year Filed
(Court, County, State)
________________ ______________ _____________________ __________
________________ ______________ _____________________ __________
________________ ______________ _____________________ __________
Please attach a copy of any Court Order issued in a case listed above.
9. Military Service:
My spouse is in the military service.
My spouse is not in the military service.
I am in the military service.
I am not in the military service.
400-00836NR Complaint for Non-Resident Divorce No Children (01/2018) Page 5 of 5
REQUEST FOR RELIEF
1. I ask that the Family Court grant me: (check each box that applies)
Decree of Divorce Decree of Dissolution
2. Division of Property as provided in the attached stipulation.
3. Spousal Maintenance (Alimony) as provided in the attached stipulation.
4. Court costs.
5. Name change: I would like to resume my former name of: ________________________
I hereby swear or affirm that the information above is true to the best of my knowledge and belief.
Dated
_____________________________ _______________________________
Signature of Plaintiff
____________________________
Printed Name
Signed and sworn to or affirmed before me:
REMEMBER TO INCLUDE YOUR SIGNED STIPULATION WITH THIS FILING.
Date Signature of Notary Public Expiration Date