Fillable STIPULATION OF PARENTAGE (Vermont Judiciary)

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STIPULATION OF PARENTAGE (Vermont Judiciary)

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400-00872 – Stipulation of Parentage (07/2018) Page 1 of 1
STATE OF VERMONT
SUPERIOR COURT
FAMILY DIVISION
Unit
Docket No.
Plaintiff
DOB
Defendant
DOB
V.
STIPULATION OF PARENTAGE
The parties hereby stipulate and agree as follows:
We _________________________, _________________________ and _________________________,
Name Name Name (if applicable)
are the parents of the child(ren) named below:
Name of Child: ____________________________________ Date of Birth: _______________________
Name of Child: ____________________________________ Date of Birth: _______________________
Name of Child: ____________________________________ Date of Birth: _______________________
Name of Child: ____________________________________ Date of Birth: _______________________
Name of Child: ____________________________________ Date of Birth: _______________________
We waive the right to a hearing on the issue of parentage.
APPROVED AS TO FORM
Dated
________________ ______________________________ ______________________________
Plaintiff’s Printed Name Plaintiff’s Signature
Dated
________________ ______________________________ ______________________________
Plaintiff’s Attorney’s Printed Name Plaintiff’s Attorney’s Signature
Dated
________________ ______________________________ ______________________________
Defendant’s Printed Name Defendant’s Signature
Dated
________________ ______________________________ ______________________________
Defendant’s Attorney’s Printed Name Defendant’s Attorney’s Signature
Dated
________________ ______________________________ ______________________________
Other Parent’s Printed Name Other Parent’s Signature
Dated
________________ ______________________________ ______________________________
Other Parent’s Attorney’s Printed Name Other Parent’s Attorney’s Signature
Dated
________________ ______________________________ ______________________________
OCS Representative’s Printed Name OCS Representative’s Signature
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STIPULATION OF PARENTAGE (Vermont Judiciary)

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Completed 30 July 2020

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