Fillable NOTICE OF APPEARANCE & INTENT TO REPRESENT MYSELF (Vermont Judiciary)

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NOTICE OF APPEARANCE & INTENT TO REPRESENT MYSELF (Vermont Judiciary)

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400-00823 – Motion to Enforce Child Support and/or Maintenance Supplement (12/2019) Page 1 of 2
STATE OF VERMONT
SUPERIOR COURT
FAMILY DIVISION
Unit
Docket No.
Name
DOB
V.
Name
DOB
NOTICE OF APPEARANCE & INTENT TO REPRESENT MYSELF
I intend to represent myself and hereby enter my appearance with the Court. No attorney will represent me in
this case unless an attorney or I notify the Court otherwise.
I understand that IT IS MY RESPONSIBILITY TO:
1. Notify the Court in writing if I change my address or phone number; and
2. Send copies of any papers I file with the Court to the other party in this case.
All Court papers may be mailed to me by first class mail at the address listed below.
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: _____________________
MOTION TO ENFORCE CHILD SUPPORT and/or MAINTENANCE SUPPLEMENT
1.
I am the ☐ Plaintiff ☐ Defendant ☐ Office of Child Support
2.
The other party is the ☐ Plaintiff ☐ Defendant
3.
I request that the Court enforce a child support order issued on (date) _______________________.
☐
By this Court
☐ By another Court: __________________________________________________________
Name of Court
_____________________________________________________________
Address of Court
4. The other party is required to pay: (check the appropriate box & fill in information)
☐ $_______________ per _______________ in Child Support
☐ $_______________ per _______________ in Maintenance Supplement
5. The other party has failed to: (check all that apply)
☐ pay Child Support as ordered by the Court.
☐ pay Maintenance Supplement as ordered by the Court.
☐ pay child’s health insurance as ordered by the Court.
☐ pay medical or other expenses as ordered by the Court.
☐ follow the Child Support Order in that he/she has failed to:
____________________________________________________________________________
400-00823 – Motion to Enforce Child Support and/or Maintenance Supplement (12/2019) Page 2 of 2
6. The other party owes the following amounts: (check all that apply)
☐ $_______________ in child support as of _______________.
☐ $_______________ in maintenance supplement as of _______________.
☐ $_______________ for health insurance, medical or other expenses as ordered by the Court.
7. A Case Accounting Affidavit from the Office of Child Support (OCS):
☐ Is attached.
☐ Is NOT attached.
8. The other party’s employer:
☐ The name of the other party’s employer is: ________
☐ I do not know the name of the other party’s employer.
☐ The other party is unemployed.
☐ The other party is self-employed.
9. Wage Withholding:
☐ The Court has previously ordered the other party’s employer to withhold child support from his
wages.
☐ The Court has NOT ordered wage withholding. (Please note that if you wish to request expedited wage
withholding, you must file a separate petition for wage withholding.)
10. I know that the other party is aware of his/her obligation under the Order because:
____________________________________________________________________________
11. This is the __________ time I have filed a petition to enforce child support against the other party.
REQUEST TO THE COURT
I request that the Court:
☐ Enter a Judgment against the other party for all unpaid amounts ordered by the Court.
☐ Order that support including arrearages be paid to:
☐ The Office for Child Support on my behalf.
☐ Directly to me.
☐ Order the other party to pay a civil penalty (up to 10%) on any amount that has been unpaid for 30
days or more.
☐ Order the other party to pay my reasonable attorney fees and costs for bringing this motion.
☐ Order the other party to conduct a good faith job search and to report when s/he gets a job.
☐ Grant any other relief this Court determines is appropriate.
I hereby swear or affirm that the information above is true to the best of my knowledge and belief.
_________________________ _____________________________
Signature
Signed and sworn to or affirmed before me:
Date Signature of Notary Public Expiration Date
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NOTICE OF APPEARANCE & INTENT TO REPRESENT MYSELF (Vermont Judiciary)

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Completed 30 July 2020

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