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/Year – this 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.