Fillable NOTICE OF APPEARANCE a nd INTENT TO REPRESENT (Vermont Judiciary)

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NOTICE OF APPEARANCE a nd INTENT TO REPRESENT (Vermont Judiciary)

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400-00809 – Notice of Appearance & Intent to Represent Myself + Petition for Wage Withholding (07/2013) Page 1 of 2
STATE OF VERMONT
SUPERIOR COURT
FAMILY DIVISION
Unit
Docket No.
Plaintiff Name
DOB
Defendant Name
DOB
v.
NOTICE OF
APPEARANCE
a
nd
INTENT TO
REPRESENT M
YS
ELF
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: ______________________________________________
Street Address: _______________________________________ City/State/Zip: ___________________________
Mailing Address
(if different from Street Address): __________________________________________________________
City/State/Zip: _______________________________________ Email Address: ___________________________
Daytime Phone: ______________________________________ Evening Phone: __________________________
PETITION FOR WAGE WITHHOLDING
Pursuant to 15 V.S.A. §782
☐ Defendant ☐ Office of Child Support
☐ Defendant
1. I am the ☐ Plaintiff
2. The other party is the ☐ Plaintiff
3. On ____________________, the other party is ordered to pay:
☐ $________________ per ______________ in Child Support.
☐ $________________ per ______________ in Maintenance Supplement.
☐ $________________ per ______________ in Spousal Maintenance (Alimony).
4. The order was issued by:
☐ this court.
☐ another court (Name & Address of Court) ___________________________________.
5. The other party has failed to pay to make payments as ordered by the Court.
6. The other party owes the following amounts:
☐ $________________ per ______________ in child support owed to me.
☐ $________________ per ______________ child support maintenance supplement owed to me.
☐ $________________ per ______________ in spousal maintenance owed to me.
☐ $________________ per ______________ in child support owed to the State of Vermont.
400-00809 – Notice of Appearance & Intent to Represent Myself + Petition for Wage Withholding (07/2013) Page 2 of 2
7. Some or all of these amounts are 7 days overdue.
8 A Case Accounting Affidavit from OCS:
☐ is attached ☐ is not attached
9. The other party’s employment:
☐ 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 self-employed.
☐ The other party is unemployed.
REQUEST TO THE COURT
I request that the Court:
☐ enter a judgment again the other party for all unpaid support.
☐ order Wage Withholding from the other party’s wages in the following manner:
$________________ per month for current support;
$________________ per month towards the arrearage balance;
☐ order that such amounts be paid directly to the Office of Child Support on my behalf.
☐ 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.
Dated
Signed and sworn to or affirmed before me:
At hear
ing, the other party may object to Wage Withholding on the basis of an error in the amount
of current support or arrearages or an error in identity.
Date Signature of Notary Public Expiration Date
Signature Defendant
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NOTICE OF APPEARANCE a nd INTENT TO REPRESENT (Vermont Judiciary)

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Completed 30 July 2020

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