Fillable INTENT TO PURSUE OR WITHDRAW COMPLAINT (Vermont Judiciary)

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INTENT TO PURSUE OR WITHDRAW COMPLAINT (Vermont Judiciary)

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100-00251SA – Intent to Pursue or Withdraw Complaint – Sexual Assault (07/2019) Page 1 of 2
STATE OF VERMONT
SUPERIOR COURT
CIVIL DIVISION
Unit
Docket No.
Plaintiff
DOB
Defendant
DOB
INTENT TO PURSUE OR WITHDRAW COMPLAINT
Sexual Assault
PURSUANT TO 12 V.S.A. §5133
Check Appropriate Box
☐ I understand my request for emergency relief has been denied. I hereby withdraw my request for a final
order against sexual assault sought under 12 V.S.A. §5133.
OR
☐ In spite of the fact that my request for emergency relief was denied, I intend to pursue my request for a
final order against sexual assault order with 12 V.S.A. §5133. I request a hearing be set.
Signature of Plaintiff Date
IMPORTANT NOTICES
INTENTION TO PURSUE OR WITHDRAW COMPLAINT FOR PROTECTION ORDER
AGAINST SEXUAL ASSAULT
IMPORTANT INFORMATION FOR PLAINTIFF
If no request for a hearing is filed within five (5) business days from the date the denial order was
issued, the request for a final order will be considered withdrawn.
INFORMATION FOR PLAINTIFF AND DEFENDANT
ABOUT REPRESENTATION BY AN ATTORNEY
Although you may represent yourself at any hearing during these proceedings, you may wish to
consult with or be represented by an attorney. If you hire an attorney to represent you, your
attorney is required to tell the Court and the other party that they will be representing you. Both
parties have the right to receive “notice” before any hearing that the opposing party will be
represented by an attorney. The Vermont Rules of Civil Procedure require that such notice must be
given to the opposing party or their attorney in person, by telephone, or in writing and it must be
given far enough in advance of the hearing to permit them to hire an attorney too. If you do not
provide such notice to the opposing party, and if the party without an attorney asks, the Court will
postpone the hearing for a reasonable time to allow the unrepresented party to obtain an attorney.
IMPORTANT INFORMATION FOR DEFENDANT
At the hearing to be held on the date and time specified on the face of this notice, the Court will
decide on whether to issue or deny a final order. After the hearing, an order may be issued, which
may remain in effect for a defined period of time, which will be stated on the order. If you fail to
appear at the hearing, an order may be issued against you granting the Plaintiff’s requests for relief
as the Court deems appropriate.
100-00251SA – Intent to Pursue or Withdraw Complaint – Sexual Assault (07/2019) Page 2 of 2
RETURN OF SERVICE
STATE OF VERMONT
SUPERIOR COURT
CIVIL DIVISION
Unit
Docket No.
I personally served:
(check all that apply)
☐ Complaint, Affidavit and Temporary Order ☐ Order to Modify/Extend/Vacate Order
☐ Temporary Order ☐ Extended Final Order
☐ Final Order ☐ Extended Temporary Order
☐ Court Service Information Sheet ☐ Denial of Emergency Relief
Intent to Pursue
☐ Amended/Modified Temporary Order Notice of hearing
☐ Amended/Modified Final Order
Upon ____________ by:
Date:_______________ Time: ____________ ☐ AM ☐ PM Place:______________________________________
Date
Officer’s Name, Title and Agency
Officer’s Signature
Acceptance of Service
I hereby accept service of this order.
Fees
Date
Signature
Service Fee
_ _ Miles X $0. per mile
(please type or print name)
Total
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INTENT TO PURSUE OR WITHDRAW COMPLAINT (Vermont Judiciary)

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Completed 30 July 2020

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