400-00153 – Motion to Modify/Extend/Vacate RFA Order (01/2019) Page 1 of 1
Plaintiff DOB Defendant DOB
MOTION TO MODIFY/EXTEND/VACATE
Relief from Abuse Order
An Order for relief from abuse was entered in the above case: ____________________
date
Th
e ☐ Plaintiff ☐ Defendant requests that this Order of the Court be:
☐ Modified as follows:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
☐ Extended until ____________________
date
☐ Vacated.
Affidavit in Support of Request
In support of this request, subject to the penalties for perjury, I state the following facts to be true to the best of my
knowledge and belief. Specifically describe the facts that support your request.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
I
swear or affirm that the facts set forth in this petition are true and correct to the best of my knowledge and belief.
Date: ___________________________ Signature: ______________________________________________
Printed Signature: ________________________________________
S
igned and sworn to before me:
D
ate: ___________________________
E
xpiration Date: ___________________ Signature of Notary: ______________________________________
N
OTICE
This affidavit will be served on opposing party with the motion to modify/extend/vacate relief from abuse.
W
ARNING:
MAKING FALSE STATEMENTS IN THIS AFFIDAVIT IS A CRIME SUBJECT TO A TERM OF IMPRISONMENT OR A FINE, OR
BOTH AS PROVIDED BY 13 V.S.A. §2904.
