Fillable Form 843: STATE OF VERMONT SUPERIOR COURT FAMILY (Vermont Judiciary)

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Form 843: STATE OF VERMONT SUPERIOR COURT FAMILY (Vermont Judiciary)

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Form 843
STATE OF VERMONT
SUPERIOR COURT FAMILY DIVISION
______________ Unit Docket No.______________
Plaintiff Defendant
Name DOB
v.
Name DOB
NOTICE OF APPEARANCE
and INTENT TO REPRESENT MYSELF
I intend to represent myself and hereby enter my appearance with the court. No attorney will
represent me in this case unless an attorney or I notify the court otherwise.
I understand that IT IS MY RESPONSIBILITY TO:
1. Notify the Court in writing if I change my address or phone number;
and
2. Send copies of any papers I file with the Court to the other party in this case.
All court papers may be mailed to me by first class mail at the address listed below.
My Street Address My Mailing Address (if different):
Town/City State Zip Town/City State Zip
Phone Number (day) Phone Number (evening)
E Mail Address
MOTION TO MODIFY PARENTAL RIGHTS AND RESPONSIBILITIES
and/or PARENT CHILD CONTACT
1. I am the
Plaintiff Defendant
2. I request that the court modify the current court order issued on ______________
Date of order
By this Court
By another Court: ____________________________________________.
Name and address of Court
Form 843 (11/2017)
3. Mediation
a. The order currently in effect requires the parties to mediate any dispute
before returning to court to request a modification of the order:
Yes
No
b. The parties have attended mediation in order to try to resolve this dispute:
Yes
No
PLEASE NOTE: If there is a provision in your current order that requires mediation,
you must try to resolve your dispute through mediation before returning to court
unless there is immediate danger to your child(ren) that requires immediate
intervention by the Court.
4. The children who are the subject of this order are:
Name DOB Name DOB
5. Parental Rights and Responsibilities
a. Modification
I am not requesting a change in legal or physical parental rights and
responsibilities. (Please go to paragraph 6.)
I am requesting that parental rights and responsibilities be changed so that:
(Please describe the change you are looking for) _____________________
____________________________________________________________
_____________________________________________________________
b. Under the current order, legal parental rights and responsibilities are held:
Jointly by both parents
Primarily or Solely by: ________________________________
And physical parental rights and responsibilities are held:
Jointly by both parents
Primarily or Solely by: ________________________________
6. Parent Child Contact Schedule
a. Modification
I am not requesting a change in the parent child contact schedule. (If you
check this box, please go to paragraph 7.)
I am requesting that the schedule be changed as follows:
(Please describe the change you are looking for) _____________________
____________________________________________________________
_____________________________________________________________
Form 843 (11/2017)
b. Current Order
Under the current order, the schedule of parent child contact is (please describe):
____________________________________________________________
_____________________________________________________________
____________________________________________________________
7. Parent Child Contact Conditions
a. Modification
I am not requesting a change in conditions
I am requesting that the conditions of contact be changed as follows:
(Please describe the change you are looking for) _____________________
____________________________________________________________
_____________________________________________________________
b. Current Order
Under the current order, the conditions of parent child contact are (please describe):
____________________________________________________________
_____________________________________________________________
____________________________________________________________
8. Change in Circumstances
The change I am requesting is necessary because there has been a real, substantial and
unanticipated change in circumstances since the current order. Please briefly describe
what has changed since the last order and attach an affidavit with a more detailed
description.
Brief Description of what has changed since the last order:
_____________________________________________________________________
_____________________________________________________________________
YOU MUST ATTACH A SEPARATE AFFIDAVIT THAT DESCRIBES THE
FACTS THAT SUPPORT YOUR REASONS FOR REQUESTING A CHANGE
INCLUDING THE CHANGE IN CIRCUMSTANCES DESCRIBED IN
PARAGRAPH 8.
REQUEST TO THE COURT
I request that the court:
Modify Parental Rights and Responsibilities as described above.
Modify the schedule of Parent Child Contact as described above.
Modify the conditions of Parent Child Contact as described above.
Form 843 (11/2017)
Grant any other relief this Court determines is appropriate.
I hereby swear or affirm that the information above is true to the best of my knowledge and
belief.
Signed and sworn to before me:
Signature Date
Date Signature of Notary Public Expiration Date
Form 843 (11/2017)
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Form 843: STATE OF VERMONT SUPERIOR COURT FAMILY (Vermont Judiciary)

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Completed 30 July 2020

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