Fillable Form 151m: (Vermont Judiciary)

Fill Online, Printable, Fillable, Blank Form 151m: (Vermont Judiciary) Form

Use Fill to complete blank online VERMONT JUDICIARY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form 151m: (Vermont Judiciary)

On average this form takes 11 minutes to complete

The Form 151m: (Vermont Judiciary) form is 3 pages long and contains:

  • 0 signatures
  • 6 check-boxes
  • 41 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Vermont Judiciary forms online.

BROWSE VERMONT JUDICIARY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Form 151m
8/14 Page 1 of 3
STATE OF VERMONT
SUPERIOR COURT
FAMILY DIVISION
Unit
Docket No.
Child’s DOB
Defendant’s Name
DOB
DOB
Defendant’s Street Address
City, State, Zip
AFFIDAVIT IN SUPPORT OF COMPLAINT FOR CHILD
In support of the claims made in my complaint and subject to the penalties for perjury, I state the following facts to be
true to the best of my knowledge and belief.
1. The most recent incident that causes me to ask for an order happened on or about
Date
at
Time
in
Town, State
when
Name of person
did the following to the minor child
named above:
(Describe what happened below. Be specific: What was the act or threat of violence? Where did it happen? Who else was there? Was a weapon
involved? Was the child or anyone else injured? What were the injuries?)
Attach a separate sheet if necessary
2. Is the incident described above the most serious incident involving the defendant? Yes No
If your answer is No, please fill in the following information:
The most serious incident that causes me to ask for an order happened on
Date
at
Time
Form 151m
8/14 Page 2 of 3
in
Town, State
(Describe what happened below. Please be specific: What was the act or threat of violence? Where
did it happen? Who else was there? Was a weapon involved? Was the child or anyone else injured?
What were the injuries?)
Attach a separate sheet if necessary
3. Other past incidents of serious violence or threats that support my request for an Order include:
(Be specific: for each incident state: When and where it happened, who else was there, and details about any injuries resulting or weapons used.)
Form 151m
8/14 Page 3 of 3
Attach a separate sheet if necessary
4. Do you feel that the child named above is in immediate danger of further abuse from the defendant? Yes No
Do you believe that the defendant poses a danger to other children in the household? Yes No
If you checked yes to either question, please explain why.
5. Is there an existing order or a pending court proceeding involving you, the Defendant and/or the child named in
the complaint? Yes No
If yes, please fill in the information requested below:
Type of Proceeding
Name of Case
Name of Court
And State
Docket Number
And Date Filed
Divorce/Separation
Civil Union Dissolution
Parentage
Relief From Abuse
Protection Order
Criminal
Guardianship
Probate
Juvenile
NOTICE: This Affidavit will be served on Defendant with your Complaint.
WARNING
MAKING FALSE STATEMENTS IN THIS AFFIDAVIT IS A CRIME SUBJECT TO A TERM OF IMPRISONMENT OR A
FINE, OR BOTH AS PROVIDED BY 13 V.S.A. §2904.
I hereby swear or affirm that the information above is true to the best of my knowledge and belief.
Signature of Plaintiff
Date
Printed Name
Signed and sworn before me:
Date
Signature of Notary Public
Expiration Date
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form 151m: (Vermont Judiciary)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 30 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document