Fillable NOTICE OF APPEARANCE a nd REPRESENT M YS (Vermont Judiciary)

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NOTICE OF APPEARANCE a nd REPRESENT M YS (Vermont Judiciary)

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400-00840 – Notice of Appearance & Intent to Represent Myself + Answer to Complaint (07/2018) Page 1 of 2
STATE OF VERMONT
SUPERIOR COURT
FAMILY DIVISION
Unit
Docket No.
Plaintiff Name
Defendant Name
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: __________________________
ANSWER TO
C
O
M
PL
A
I
N
T
I am the Defendant in this case. This is my answer to the facts in the Plaintiff’s Complaint: (Please refer to the
Plaintiff’s Complaint and check whether you agree or disagree with the facts in each paragraph of the Complaint.)
Disagree
Don’t Know
1.
Minor Child(ren)
☐
☐
☐
2.
Relationship of Plaintiff to Child(ren)
☐
☐
☐
3.
Relationship of Defendant to the Child(ren)
☐
☐
☐
4.
Other possible parents
☐
☐
☐
5.
Jurisdiction
☐
☐
☐
6.
Facts related to the UCCJEA Jurisdiction
☐
☐
☐
7.
Public Assistance
☐
☐
☐
8.
Earlier Actions for Parentage or Separate Support
☐
☐
☐
9.
Relief from Abuse or Protective Order Proceeding
☐
☐
☐
10.
Military Status
☐
☐
If you disagree with any of the facts in Plaintiff’s Complaint, please write the paragraph number below
and state the facts you believe to be true:
400-00840 – Notice of Appearance & Intent to Represent Myself + Answer to Complaint (07/2018) Page 2 of 2
C
O
UN
TER CL
A
I
M
I ask that the Family Court grant the following requests (check each box that applies)
1. ☐ Parentage Order: A finding that _____________________, _____________________ and
Name Name
_____________________ (if applicable) are the parents of the child(ren) named in the complaint.
Name
2. ☐ Parental Right and Responsibilities
Legal parental rights and responsibilities:
☐ Shared jointly
☐ Given solely to ☐ Plaintiff ☐ Defendant ☐ Other
Physical parental rights and responsibilities:
☐ Shared jointly
☐ Given solely to ☐ Plaintiff ☐ Defendant ☐ Other
3. ☐ Parent Child Contact for ☐ Plaintiff ☐ Defendant ☐ Other
4. Name change of child(ren)
☐ Not seeking name change
☐ Order that the names of the child(ren) be changed
Is now _________________________changed to _________________________
Is now _________________________changed to _________________________
Is now _________________________changed to _________________________
Is now _________________________changed to _________________________
Is now _________________________changed to _________________________
5. ☐ Order Genetic Testing
6. ☐ Child support and medical support for the minor child(ren)
7. ☐ Court costs
8. ☐ Attorney fees
I hereby swear or affirm that the information above is true to the best of my knowledge and belief.
Dated
Signature Defendant
Signed and sworn to or affirmed before me:
Quick Reference Guide: NOTE if you are unsure if you meet the criteria to be established as a “parent”, seek legal advice before
submitting this Complaint with the Court.
“Presumed parent” means a person who is married to the person who gave birth to the child(ren) during the marriage or a person who is
married to the person who gave birth to the child(ren) and the child(ren) is/are born no later than 300 days after the marriage is
terminated.
“Acknowledged parent” means a person who has given birth to the child(ren) or who is the alleged genetic parent that has signed a
Voluntary Acknowledgement of Parentage form.
“Adjudicated parent” means a person who has been adjudicated by a Court of competent jurisdiction to be a parent of a child(ren).
“De Facto Parent” is a person who has resided with the child(ren) as a regular member of the household for a significant period of time
“Intended parent” is a person, whether married or unmarried, who manifests the intent to be legally bound as a parent of a child(ren)
resulting from assisted reproduction or a gestational carrier agreement
Date Signature of Notary Public Expiration Date
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NOTICE OF APPEARANCE a nd REPRESENT M YS (Vermont Judiciary)

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Completed 30 July 2020

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