Fillable MOTION TO TERMINATE/RENEW EXTREME RISK PROTECTION ORDER (Vermont Judiciary)

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MOTION TO TERMINATE/RENEW EXTREME RISK PROTECTION ORDER (Vermont Judiciary)

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400-00303 – Extreme Risk Motion to Renew/Terminate Protection Order (06/2018) Page 1 of 1
STATE OF VERMONT
SUPERIOR COURT
FAMILY DIVISION
Unit
Docket No.
Petitioner Respondent Date Of Birth
State of Vermont
V.
MOTION TO TERMINATE/RENEW EXTREME RISK PROTECTION ORDER
An Order for extreme protection was entered in the above case on: ____________________.
The ☐ Petitioner ☐ Respondent requests that this Order of the Court be:
☐Terminated
☐Renewed until ______________________________
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.)
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Dated
_____________________________ ________________________________________
Signature
_____________________________________
Print Name
Signed and sworn to before me:
NOTICE
This affidavit will be served on opposing party with a copy of the Motion to Terminate/Renew the
Extreme Risk Protection Order.
WARNING
MAKING A FALSE STATEMENT IN THIS AFFIDAVIT IS A CRIME SUBJECT TO A TERM OF IMPRISONMENT OR A FINE, OR
BOTH, AS PROVIDED BY 13 V.S.A. § 4058
Date Signature of Notary Public Expiration Date
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MOTION TO TERMINATERENEW EXTREME RISK PROTECTION ORDER (Vermont Judiciary)

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Completed 30 July 2020

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