Fillable Form 700 00137 (Vermont Judiciary)

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Form 700 00137 (Vermont Judiciary)

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700-00137 – Statement of Adoptive Parent Expenses (04/2017) Page 1 of 1
STATE OF VERMONT
SUPERIOR COURT
PROBATE DIVISION
Unit
Docket No.
In re Adoption of:
ADOPTIVE PARENT EXPENSES
15A V.S.A. § 3-702
Child’s Name:
Name(s):
Address:
Birthparents’ Names (if known):
Telephone #:
Dat
e
Name of
Recip
i
en
t
Purpose of Pay
m
en
t
TOT
AL
S
I/We swear and affirm that the expenses listed above are the only disbursements we have made in connection with the adoption of the child listed above.
________________ ______________________________ ________________ ______________________________
Date
Signature of Adoptive Parent
Date
Signature of Adoptive Parent
Signed and sworn to before me:
Date Signature of Notary Public Expiration Date
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Completed 15 July 2020

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