Fillable FAMILY DIVISION Docket No. Certificate of Notice to (Vermont Judiciary)

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FAMILY DIVISION Docket No. Certificate of Notice to (Vermont Judiciary)

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400-00853 – Certificate of Notice to Plaintiff by Interested Person (09/2017) Page 1 of 1
Plaintiff DOB Defendant DOB
V.
Certificate of Notice to Plaintiff by Interested Person
Pursuant to 33 V.S.A. Section 6936(b)
☐ I certify that I have given notice to Plaintiff ______________________________ of this action by:
☐ delivering a copy of the attached Complaint for Relief from Abuse/Neglect/Exploitation at
_________________________________________________________________________________
☐ Other: ___________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Dated
_____________________________ ___________________________________
Signature of Plaintiff
Receipt of Notice by Plaintiff
☐ I have received a copy of the Complaint for Relief from Abuse/Neglect/Exploitation.
☐ I wish to pursue the Complaint for Relief from Abuse/Neglect/Exploitation.
☐ I do not wish to pursue the Complaint for Relief from Abuse/Neglect/Exploitation.
☐ Plaintiff is unable to sign for receipt of notice because:
_____________________________________________________________________________________
_____________________________________________________________________________________
Dated
_____________________________ ___________________________________
Interested Person
STATE OF VERMONT
SUPERIOR COURT
Unit
FAMILY DIVISION
Docket No.
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FAMILY DIVISION Docket No. Certificate of Notice to (Vermont Judiciary)

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Completed 30 July 2020

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