400-00836NoChildren – Complaint for Divorce/Legal Separation/Dissolution No Children (05/2020) Page 1 of 4
STATE OF VERMONT
SUPERIOR COURT
FAMILY DIVISION
Unit
Docket No.
Plaintiff Name
Defendant Name
v.
Plaintiff Information:
Name: __________________________________________ Date of Birth: __________________________
Street Address: ___________________________________ City/State/Zip: _________________________
Mailing Address
(if different from Street Address): _______________________________________________________
City/State/Zip: ____________________________________ Email Address: _________________________
Daytime Phone: ___________________________________ Evening Phone: ________________________
Attorney Name: ___________________________________ Attorney Phone: _______________________
Defendant Information:
Name: __________________________________________ Date of Birth: __________________________
Street Address: ___________________________________ City/State/Zip: _________________________
Mailing Address
(if different from Street Address): _______________________________________________________
City/State/Zip: ____________________________________ Email Address: _________________________
Daytime Phone: ___________________________________ Evening Phone: ________________________
Attorney Name: ___________________________________ Attorney Phone: _______________________
SUMMONS
THIS SUMMONS IS DIRECTED TO: __________________________________________________________
Name of
Defendant
1. PLAINTIFF _________________________________________________ IS SEEKING A
Name of Plaintiff
DIVORCE LEGAL SEPARATION CIVIL UNION DISSOLUTION
The Plaintiff’s Complaint begins on the next page. Do not throw these papers away. They are official papers that
affect your rights.
2. TO PROTECT YOUR RIGHTS, YOU SHOULD REPLY WITHIN 21 DAYS. Your written response is called an
Answer. You can get an official court form for an Answer to a Divorce Complaint at any Vermont Family
Court or on the Judiciary web site at http://www.vermontjudiciary.org.
3. YOU MUST RESPOND TO EACH CLAIM. In your Answer you must state whether you agree or disagree with
each paragraph of the Complaint. If you believe the Plaintiff should not be given everything asked for in
the Complaint, you should say so in your Answer.
4. IF YOU DO NOT FILE AN ANSWER OR FILE AN APPEARANCE, THE COURT IS NOT REQUIRED TO NOTIFY
YOU OF HEARINGS. If you do not attend the court hearings, the Plaintiff may receive everything
requested in the Complaint. You will not get a chance to tell your side of the story.
5. YOU MUST GIVE OR SEND A COPY OF YOUR ANSWER TO THE PLAINTIFF. If the Plaintiff has an attorney,
you must give or send a copy of your answer to the Plaintiff’s attorney.
400-00836NoChildren – Complaint for Divorce/Legal Separation/Dissolution No Children (05/2020) Page 2 of 4
6. YOU MUST GIVE OR SEND YOUR ORIGINAL ANSWER TO THE COURT at this address:
7. LEGAL ASSISTANCE: You may wish to get help from a lawyer. Even if you cannot get
legal help, you must still give the Court a written Answer to protect your rights.
Dated
_____________________________ ___________________________________
Signature of Court Clerk
Select Address
400-00836NoChildren – Complaint for Divorce/Legal Separation/Dissolution No Children (05/2020) Page 3 of 4
COMPLAINT FOR DIVORCE/LEGAL SEPARATION/DISSOLUTION
FACTS
The Plaintiff states that the following facts are true:
1. Residence:
(A)
I am now a resident of , .
County State
I have resided in Vermont for 6 full months.
(B)
Defendant is now a resident of _, .
County State
Defendant has resided in Vermont for 6 full months, since _____________________.
Month/Date/Year
2.
Marriage:
We were married at , ___________________
City State
on
and are still married.
Month/Date/Year
Civil Union:
Our civil union took place at , ___________________
City State
on
and it has never been dissolved.
3.
Grounds for Divorce/Legal Separation/Dissolution: The reason I am asking for a
Divorce Legal Separation Dissolution
Is that:
Six Month Separation: We have or will have lived separate and apart for more than six (6)
consecutive months and it is not reasonably probable that we can resume our relationship.
The Defendant and I separated on: _____________________________.
Month/Date/Yearthis field is required
Other:
(Please explain)
4.
Property, Assets and Debts: I am I am not filing with this Complaint, a completed Financial
form 400-00813B that lists all of the property, assets and debts that my spouse and I own together
or separately that are known to me.
5.
Public Assistance:
I receive assistance from the Division of Economic Services (DES) (examples: Food Stamps, Reach Up).
The Defendant receives public assistance from the Division of Economic Services (DES).
6.
Earlier actions for divorce, legal separation, dissolution, annulment:
I have not filed for divorce, legal separation, dissolution or annulment in any court against the
Defendant, as far as I know, the Defendant has not filed for divorce, legal separation, dissolution or
annulment against me.
I have filed OR the Defendant has filed for divorce, legal separation, dissolution or annulment before
the date of the filing of this petition. (If you check this box, you must fill in the information below.
Use an additional page if necessary.)
Type of Action Who Filed Where Filed Year Filed
(Court, County, State)
________________ ______________ _____________________ __________
________________ ______________ _____________________ __________
________________ ______________ _____________________ __________
Please attach a copy of any Court Order issued in a case listed above.
400-00836NoChildren – Complaint for Divorce/Legal Separation/Dissolution No Children (05/2020) Page 4 of 4
7.
Relief from abuse or protective order proceedings:
I have not filed a complaint for relief from abuse or a request for a protective order against the
Defendant AND, as far as I know, the Defendant has not filed such an action against me.
I have filed a complaint for relief from abuse or a request for a protective order against the
Defendant OR the Defendant has filed a complaint for relief from abuse or a request for a protective
order against me. (If you check this box, you must complete the information below. Use an
additional page if necessary.)
Type of Action Who Filed Where Filed Year Filed
(Court, County, State)
________________ ______________ _____________________ __________
________________ ______________ _____________________ __________
________________ ______________ _____________________ __________
Please attach a copy of any Court Order issued in a case listed above.
8.
Military Service:
The Defendant is in the military service.
The Defendant is not in the military service.
I am in the military service.
I am not in the military service.
REQUEST FOR RELIEF
1. I ask that the Family Court grant me: (check each box that applies)
Decree of Divorce Decree of Legal Separation Decree of Dissolution
2. Division of Property (divide our property, assets and debts).
3. Spousal Maintenance (Alimony).
4. Court costs.
5. Attorney fees.
6. Name change: I would like to resume my former name of:
I have attached a written agreement signed by my spouse and myself. I ask that the Court
issue an order that includes the provisions of our written agreement. (In order to qualify for the
reduced filing fee, the attached agreement must cover all the issues that the Plaintiff seeks to have
the Court resolve.)
I hereby swear or affirm that the information above is true to the best of my knowledge and belief.
Dated
_____________________________ ___________________________________
Signature of Plaintiff
___________________________________
Printed Name
Signed and sworn to or affirmed before me:
Date Signature of Notary Public Expiration Date