500-00703 Vermont Request for Civil Violations Complaints (03/2019) Page 1 of 1
Vermont Judicial Bureau
PO Box 607
White River Junction, VT 05001
Phone: 802-295-8869
www.vermontjudiciary.org
JUD.VJB@vermont.gov
Request for Vermont Civil Violation Complaints
Department Name: _________________________________ 4 Digit Number (Required): _____________
Printed Name: _____________________________________ Job Title: ____________________________
Phone: ___________________________
Shipping Address:
(Street) ___________________________________________________________
(City/Town) ______________________________________ (State) VT (Zip) ______________
The Judicial Bureau will notify local police agencies when Complaints and/or Envelopes are ready for pickup
Quantity
VCVC Books ___________
MUNICIPAL Books ___________
FISH & WILDLIFE Books ___________
Striped Envelopes ___________
Local agencies will be notified when pickup is ready;
Complaints to distant agencies will be shipped by UPS
Please allow 10-15 business days for request to be processed
Email this form to: jud.vjb@vermont.gov
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FOR JUDICIAL BUREAU USE ONLY
VCVC# ______________ to# ____________ Book Total ____________
VCVC# ______________ to# ____________ Book Total ____________
Date Shipped ________________ Clerk ____________________
Date/Clerk entered Book Management System ________________/________________________
Weight
Box #1 ____________
Box #2 ____________
Box #3 ____________
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