Form 801
Vermont
Docket Number
County
Family Court
Plaintiff
Defendant
VS.
A hearing will be held on the establishment of child support and, if necessary, on the establishment of a temporary
or interim order on parental rights and responsibilities (custody) and other issues raised in the complaint.
Day of Week
Time
Date
at
The hearing will be held on:
Location of Courthouse
at:
At this hearing, the Court will determine whether to order child support and whether to require the employer
of the plaintiff or the defendant to withhold wages from the person obligated to pay child support.
Both the plaintiff and defendant must complete the attached Affidavit of Income and Assets and file it with the Court
prior to the hearing date or bring it to the hearing.
On or before the hearing date, the plaintiff and defendant must exchange tax returns for the two most recent
years in which returns were filed, along with all schedules and documentation that were submitted to the
Internal Revenue Service. A written certification must be submitted to the Court that this exchange has been
completed.
Both plaintiff and defendant must also file or bring to the hearing:
• pay stubs for the four most recent pay periods in which employment income was received, if any;
• monthly income and expense statements or equivalent documents covering the period following a
self-employed person's last-filed income tax return; and
• documentation of all other income received during the period following any person's last-filed
income tax return (including social security, workers' compensation, unemployment
compensation, disability and pensions).
Failure to provide these documents may create a presumption that the noncomplying parent's gross
income is the greater of:
• $63,634.50 which is 150 percent of the current "annual average covered wage for all
employment" as calculated by the Department of Employment and Training.
The Court may issue an order on parental rights and responsibilities (custody) and parent-child contact
(visitation) even if both parties don't appear at the hearing.
The Office of Child Support is available to assist the plaintiff and defendant to prepare for the hearing.
If you would like information about their services, you may contact them at 1-800-786 3214.
Court Clerk
Date
Rev. 7/15 SML
NOTICE OF HEARING - PETITION TO ESTABLISH CHILD SUPPORT
YOU MUST APPEAR AT THIS HEARING!
• the gross income indicated by any evidence presented to the Court; OR
AM
PM
