500-00422 – Judicial Bureau Motion (04/2019) Page 1 of 1
Vermont Judicial Bureau
PO Box 607
White River Junction, VT 05001
Phone: 802-295-8869
www.vermontjudiciary.org
JUD.VJB@vermont.gov
JUDICIAL BUREAU MOTION
DEFENDANT INFORMATION
Name: ____________________________________________________________
Mailing Address Street: ______________________________________________
City: _____________________________ State: ______ Zip: ___________
Date of Birth: _________________________ Phone: ______________________
Email Address: ________________________
COMPLAINT NUMBER: _____________________
I, ______________________________________
request the Court to consider the following request:
☐ Motion for Relief from Judgment.*
☐ Motion to Acknowledge Completion of Non-Monetary Penalty.
☐ Other Request* ________________________________________________________________
I submit the following information and facts to support my request:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Date: ________________ _______________________________
Signature Required
_______________________________
Printed Name
* A $45.00 FILING FEE REQUIRED.
