400-00153 – Motion to Modify Temporary RFA Order Prior to Scheduled Hearing (01/2019) Page 1 of 1
MOTION TO MODIFY TEMPORARY RELIEF FROM ABUSE ORDER
PRIOR TO SCHEDULED HEARING
I am the Defendant in this case. I cannot wait until the date of the hearing specified in the Temporary Order for Relief
From Abuse because of compelling reasons detailed below in the Affidavit. I request modification of the terms of the
Order relating ONLY to:
☐ Parental Rights & Responsibilities and/or ☐ Possession of the residence
☐ I will not be represented by an attorney
☐ I will be represented by an attorney. My attorney’s name, address and phone number are:
Attorney Information:
Name: _________________________________________ Phone: ___________________________
Address: ________________________________________________________________________________
Da
te: ___________________________ Defendant’s Signature: _________________________________
Printed Signature: _____________________________________
Affidavit in Support of Motion to Modify Temporary Relief From Abuse Order
In support of this request to modify the Order, subject to the penalties for perjury, I state the following facts to be true
to the best of my knowledge and belief about the present situation. The compelling reasons for modification of the
Order are:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
I s
wear or affirm that the facts set forth in this petition are true and correct to the best of my knowledge and belief.
Date: ___________________________ Defendant’s Signature: _______________________________
Printed Signature: _______________________________
Signed and sworn to before me:
Da
te: ___________________________
Exp
iration Date: ___________________ Signature of Notary: ___________________________________
NOTICE
This affidavit will be served on Plaintiff with the Motion to Modify.
WA
RNING:
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.
