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SUMMONS AND VERIFIED COMPLAINT TO ESTABLISH PARENTAGE AND/OR (Vermont Judiciary)

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Page 1 of 8
400-00817 – Complaint & Summons – Parentage (05/2020)
STATE OF VERMONT
SUPERIOR COURT
FAMILY DIVISION
Unit
Docket No.
Plaintiff Name
v.
Defendant Name
SUMMONS AND VERIFIED COMPLAINT TO ESTABLISH
PARENTAGE AND/OR RELATED OBLIGATIONS
Plaintiff Information:
Name:
Street Address:
Date of Birth:
City/State/Zip:
Mailing Address (if different from Street Address):
City/State/Zip:
Daytime Phone:
Attorney Name:
Email Address:
Evening Phone:
Attorney Phone:
De
fendant Information:
Name:
Street Address:
Date of Birth:
City/State/Zip:
Mailing Address (if different from Street Address):
City/State/Zip:
Daytime Phone:
Attorney Name:
Email Address:
Evening Phone:
Attorney Phone:
Ot
her possible parent, if any (notice will be sent)
Name:
Street Address:
Date of Birth:
City/State/Zip:
Mailing Address (if different from Street Address):
City/State/Zip:
Daytime Phone:
Attorney Name:
Email Address:
Evening Phone:
Attorney Phone:
☐ Attached is a Supplemental Information Sheet (form 400-00817A)
Regarding additional Other Possible Parents
Page 2 of 8
400-00817 – Complaint & Summons – Parentage (05/2020)
SUMMONS
THIS SUMMONS IS DIRECTED TO:
Name of Defendant
1.
PLAINTIFF
Name of Plaintiff
HAS FILED A COMPLAINT TO ESTABLISH PARENTAGE AND/OR RELATED OBLIGATIONS for certain minor
children. The children are named in the Complaint which begins on the next page. Do not throw these
papers away. They are official papers that affect your rights.
2. TO PROTECT YOUR RIGHTS, YOU SHOULD REPLY WITHIN 21 DAYS. Your written response is called an
Answer. You can get an official court form for an Answer to a Parentage Complaint at any Vermont Family
Court or on the Judiciary web site at: http://www.vermontjudiciary.org
3. YOU MUST RESPOND TO EACH CLAIM. In your Answer, you must state whether you agree or disagree with
each paragraph of the Complaint. If you believe the Plaintiff should not be given everything requested in
the Complaint, you should say so in your Answer.
4. IF YOU DO NOT FILE AN ANSWER OR FILE AN APPEARANCE, THE COURT IS NOT REQUIRED TO NOTIFY
YOU OF HEARINGS. If you do not attend the court hearings, the Plaintiff may receive everything requested
in the Complaint. You will not get a chance to tell your side of the story.
5. YOU MUST GIVE OR SEND A COPY OF YOUR ANSWER TO THE PLAINTIFF. If the Plaintiff has an attorney,
you must give or send a copy of your Answer to the Plaintiff’s attorney.
6. YOU MUST GIVE OR SEND YOUR ORIGINAL ANSWER TO THE COURT at this address:
Select Address
7. LEGAL ASSISTANCE: You may wish to get help from a lawyer. Even if you cannot get legal help, you must
still give the Court a written Answer to protect your rights.
Dated
Signature of Court Clerk
Page 3 of 8
400-00817 – Complaint & Summons – Parentage (05/2020)
VERIFIED COMPLAINT TO ESTABLISH PARENTAGE
AND/OR RELATED OBLIGATIONS
FACTUAL INFORMATION
The Plaintiff states that the following facts are true:
1. Minor Children
The children who are the subject of this parentage action are:
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: ____________________________
2. Plaintiff is (check all that apply):
□ the genetic or adoptive mother of the children named above;
□ the genetic or adoptive father of the children named above;
□ a child named above
□ presumed parent
CHECK IF APPLICABLE:
□ Plaintiff and Defendant were married on (date)_________________.
List Child(ren) Name(s)_________________________________________________________________
were born during our marriage;
Quick Reference Guide: NOTE if you are unsure if you meet the criteria to be established as a “parent,” please
seek legal advice before submitting this complaint with the court.
“Presumed parent” A person is presumed to be a parent of a child if:
• the person and the person who gave birth to the child are married to each other and the child is born during
the marriage; or
• the person and the person who gave birth to the child were married to each other and the child is born not
later than 300 days after the marriage is terminated by death, annulment, declaration of invalidity, divorce, or
dissolution; or
• the person and the person who gave birth to the child married each other after the birth of the child and the
person at any time asserted parentage of the child and the person agreed to be and is named as a parent of
the child on the birth certificate of the child; or
• the person resided in the same household with the child for the first two years of the life of the child,
including periods of temporary absence, and the person and another parent of the child openly held out the
child as the person’s child.
“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
the 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 and meets other legal criteria.
“Intended parent” is a person, whether married or unmarried, who intends to be legally bound as a parent of
the child(ren) resulting from assisted reproduction or a gestational carrier agreement.
Page 4 of 8
400-00817 – Complaint & Summons – Parentage (05/2020)
□ Plaintiff and Defendant were divorced on (date)_________________.
List Child(ren) Name(s)_________________________________________________________________
were born within 300 days after the date the marriage terminated (by divorce, annulment or
operation of law);
□ Plaintiff and Defendant married each other after the birth of
List Child(ren) Name(s)_________________________________________________________________
Defendant asserted parentage of the child, and agreed to be and is named as a parent of
List Child(ren) Name(s)_________________________________________________________________
on the birth certificate;
□ Plaintiff and Defendant resided in the same household with
List Child(ren) Name(s)_________________________________________________________________
for the first two years of his/her life, including periods of temporary absence, and Plaintiff and
Defendant openly held out
List Child(ren) Name(s)_________________________________________________________________
as the Plaintiff’s/Defendant’s child.
□ acknowledged parent (a copy of the Voluntary Acknowledgement of Parentage form must be
included)
□ adjudicated parent
□ de facto parent*
□ intended parent
□ a personal representative of a child named above
□ Other: state the nature of parental relationship to the child(ren)
3. Defendant is (check all that apply):
□ the genetic or adoptive mother of the children named above;
□ the genetic or adoptive father of the children named above;
□ presumed parent
CHECK IF APPLICABLE:
□ Defendant and Plaintiff were married on (date)_________________.
List Child(ren) Name(s)_________________________________________________________________
were born during our marriage;
□ Defendant and Plaintiff were divorced on (date)_________________.
List Child(ren) Name(s)_________________________________________________________________
were born within 300 days after the date the marriage terminated (by divorce, annulment or
operation of law);
□ Defendant and Plaintiff married after the birth of
List Child(ren) Name(s)_________________________________________________________________
Plaintiff asserted parentage of the child, and agreed to be and is named as a parent of
List Child(ren) Name(s)_________________________________________________________________
on the birth certificate;
*A party filing as a de facto parent must file an additional affidavit.
See De Facto Parentage Guide for details
Page 5 of 8
400-00817 – Complaint & Summons – Parentage (05/2020)
□ Defendant and Plaintiff resided in the same household with
List Child(ren) Name(s)_________________________________________________________________
for the first two years of his/her life, including periods of temporary absence, and Plaintiff and
Defendant openly held out
List Child(ren) Name(s)_________________________________________________________________
as the Plaintiff’s/Defendant’s child.
□ acknowledged parent (a copy of the Voluntary Acknowledgement of Parentage form must be
included)
□ adjudicated parent
□ de facto parent*
□ intended parent
□ Other: state the nature of parental relationship to the child(ren) ____________________
4. Other possible parents (check one)
□ The child(ren) do not have any other parents.
OR
□ The child(ren) do have another parent named above. That parent’s name is:
_ ____________________and his/her address is:
________________________________________________________________________________
The nature of the relationship is (please describe):
_______________________________________________________________________________
5. The court has jurisdiction because:
□ Defendant resides in Vermont
□ Defendant does not reside in Vermont (check all box that applies)
□ Defendant is personally served with notice of the proceeding within Vermont
□ Defendant submits to the Jurisdiction of Vermont by consent in a record by entering a general
appearance, or by filing with the tribunal a responsive document having the effect of waiving
any contest to personal jurisdiction
□ Defendant resided with the child(ren) in Vermont from to
date date
□ Defendant resided in Vermont and provided prenatal expenses or support for the child(ren)
□ The child(ren) resides in Vermont as a result of the acts or directives of the Defendant
□ Defendant engaged in sexual intercourse in Vermont and the child(ren) may have been
conceived by that act of intercourse
□ Defendant asserted parentage of a child(ren) in the putative father registry maintained in
Vermont by the Probate Division of Superior Court in the District of Chittenden
□ Any other basis consistent with the constitution of Vermont and the United States for the
exercise of personal jurisdiction
*A party filing as a de facto parent must file an additional affidavit.
See De Facto Parentage Guide for details
Page 6 of 8
400-00817 – Complaint & Summons – Parentage (05/2020)
6. UCCJEA Jurisdiction:
A.
During the last five years, the children listed above have lived at the following addresses with the
following household members: (Begin with the child’s residence just before this court case and list all addresses
for the past five years.) Information required under 15 V.S.A. § 1071
Address Dates Names of all Persons
(include street/city/state) (from when to when) (living in the household with the child)
Use additional page if you need more space. If children have lived at different addresses from each other, please
indicate the addresses for each child.
B.
If the current address of any household member listed in the last column is different from the
address listed above, please provide a current address for that person in the box above or on
another page.
C.
Please check the box below if the statement next to it is true.
□ I have participated as a party, witness, or in some other way in a case about the custody of this
child or these children in a Vermont court or in another state.
□ I have information about a case concerning the custody of this child or these children that is now
pending in a case in a Vermont court or in another state.
□ I have knowledge about a person who is not a party to this case who has physical custody of this
child or these children or who claims to have custody of or visitation rights with this child or
these children.
7. Public Assistance
□ I receive assistance from the Division of Economic Services
□ Defendant receives public assistance from the Division of Economic Services
□ Other possible parent receives public assistance from the Division of Economic Services
8. Earlier action for parentage, divorce, annulment or separate support
□ I have not filed for establishment of parentage, divorce, legal separation, annulment or separate
support in any court against the ☐ Defendant ☐ Other possible parent AND, as far as I know, the
□ Defendant ☐ Other possible parent has not brought an action for parentage, divorce, legal
separation, civil union, annulment or separate support against me.
□ I have filed or the ☐ Defendant ☐ Other possible parent has filed for establishment of parentage,
divorce, legal separation, annulment or separate support before the date of the filing of this
petition.
(If you check this box, you must complete the information below. Use an additional
sheet
of
paper if necessary.
Type of Action Who Filed Where Filed (Court, County, State) Year Filed
Please attach a copy of any Court Order issued in a case listed above.
Page 7 of 8
400-00817 – Complaint & Summons – Parentage (05/2020)
9. Relief from abuse/protective order or other proceedings:
□ I have not filed a complaint for relief from abuse or a request for a protective order against the
□ Defendant ☐ Other possible parent AND, as far as I know, the ☐ Defendant
□ Other possible parent has not filed such an action against me.
□ I have filed a complaint for relief from abuse or a request for a protective order against the
□ Defendant ☐ Other possible parent OR ☐ Defendant ☐ Other possible parent has filed a
complaint for relief from abuse or a request for a protective order against me. (If you check this box, you
must complete the information below. Use an additional page if necessary.)
Type of Action Who Filed Where Filed (Court, County, State) Year Filed
Please attach a copy of any Court Order issued in a case listed above.
10. Military Service:
□ The Plaintiff ☐ The Defendant ☐ Other possible parent is in the military service.
□ The Plaintiff ☐ The Defendant ☐ Other possible parent is not in the military service.
Attachments:
□ A copy of a genetic testing report.
□ A copy of the Voluntary Acknowledgement of Parentage.
□ A copy of the Denial of Parentage.
□ A copy of the Birth Certificate.
REQUEST FOR RELIEF
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
Page 8 of 8
400-00817 – Complaint & Summons – Parentage (05/2020)
6. ☐ Child support and medical support for the minor child(ren)
7. ☐ Court costs
8. ☐ Attorney fees
9. ☐ I have attached a written agreement signed by Defendant and myself. I ask that the Court issue
an order that includes the provisions of our written agreement. (In order to qualify for the reduced filing
fee, the attached agreement must cover all the issues that the Plaintiff seeks to have the Court resolve.)
I hereby swear or affirm that the information above is true and correct to the best of my knowledge and belief.
Dated
Signature of Plaintiff
Signed and sworn to or affirmed before me:
Printed Name
Date Signature of Notary Public Expiration Date
5. ☐ Order Genetic Testing
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SUMMONS AND VERIFIED COMPLAINT TO ESTABLISH PARENTAGE ANDOR (Vermont Judiciary)

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Completed 30 July 2020

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