Fillable STATEMENT OF RESPONDENTS ASSETS and INCOME (Vermont Judiciary)

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STATEMENT OF RESPONDENTS ASSETS and INCOME (Vermont Judiciary)

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PG72 – Statement of Respondent’s Assets & Income (09/2014) Page 1 of 1
STATE OF VERMONT
SUPERIOR COURT
PROBATE DIVISION
Unit
Docket No.:
In re Guardianship of :
STATEMENT OF RESPONDENT’S ASSETS and INCOME
ASSETS
Assets include real estate, investment accounts, bank accounts, vehicles and any other assets of significant value.
List only those assets that are in Respondent’s sole name.
Description of Asset
Approx. Value
Description of Asset
Approx. Value
TOTAL VALUE
INCOME
Description of Income Source (include benefits and pensions)
Amount per month
TOTAL
Include more sheets if necessary
Date
Signature of Petitioner
Printed Name
Statement of Assets and Income: Sheet ___ of ____.
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STATEMENT OF RESPONDENTS ASSETS and INCOME (Vermont Judiciary)

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Completed 30 July 2020

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