Fillable ffidavit in Support of Request for Emergency Relief (Vermont Judiciary)

Fill Online, Printable, Fillable, Blank ffidavit in Support of Request for Emergency Relief (Vermont Judiciary) Form

Use Fill to complete blank online VERMONT JUDICIARY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

ffidavit in Support of Request for Emergency Relief (Vermont Judiciary)

On average this form takes 13 minutes to complete

The ffidavit in Support of Request for Emergency Relief (Vermont Judiciary) form is 2 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 51 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Vermont Judiciary forms online.

BROWSE VERMONT JUDICIARY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
400-00852 – Affidavit in Support of Request for Abuse/Neglect/Exploitation (01/2017) Page 1 of 2
STATE OF VERMONT
SUPERIOR COURT
FAMILY DIVISION
Unit
Docket No.
Plaintiff Date of Birth Defendant Date of Birth
V.
A
ffidavit in Support of Request for Emergency Relief
From Abuse/Neglect/Exploitation
Pursuant to 33 V.S.A. Chapter 69
In support of the claims made in Plaintiff's request for Emergency Relief from Abuse/Neglect/Exploitation, I
state the following facts, which are true to the best of my knowledge and belief, about the abusive, neglectful
or exploitive treatment and present situation: Specifically describe the facts that support the claim(s) of
abuse/neglect/exploitation:
The most recent incident that causes me to ask for an order happened on ___________________ at
(date)
_______________ in the town of _______________________________, in the state of __________________
(time)
When _________________________________ did the following to me and/or the minor children:
(name)
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
(attach a separate sheet of paper if necessary)
Is the incident described above the most serious incident involving the defendant? ☐ Yes ☐ No
If you answered NO:
The most serious incident that causes me to ask for an order happened on ___________________ at
(date)
_______________ in the town of _______________________________, in the state of _____________.
(time)
Describe what happened below. (Be specific. Where did it happen? Who else was there? Was a weapon involved?)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
(attach a separate sheet of paper if necessary)
400-00852 – Affidavit in Support of Request for Abuse/Neglect/Exploitation (01/2017) Page 2 of 2
Other past incidents of serious violence or threats that support my request for an Order include:
(Be specific. For each incident, state: When and where it happened, who else was there, and details about any injuries resulting or
weapons used.)
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
(attach a separate sheet of paper if necessary)
Is there an existing order or a pending court proceeding involving you or the defendant? ☐ Yes ☐ No
If YES, please fill in the information requested below:
Type of Proceeding Name of Case Name of Court & State Docket Number
Divorce/Separation ___________________ _____________________ __________________
Civil Union ___________________ _____________________ __________________
Dissolution Parentage ___________________ _____________________ __________________
Relief from Abuse ___________________ _____________________ __________________
Protection Order ___________________ _____________________ __________________
Criminal __________________ ___________________ ________________
Guardianship ___________________ _____________________ __________________
Probate ___________________ _____________________ __________________
Juvenile ___________________ _____________________ __________________
WARNING
MAKING FALSE STATEMENTS IN THIS AFFIDAVIT IS A CRIME SUBJECT TO A TERM OF IMPRISONMENT OR A
FINE, OR BOTH AS PROVIDED BY 13 V.S.A §2904
I hereby swear under penalty of perjury that the information above is true and correct to the best of my
knowledge and belief.
Dated
_____________________________ ________________________________________
Signature of Plaintiff/Attorney/Interested Person
_____________________________________
Print Name
NOTICE: This Affidavit will be served on Defendant with the Complaint for Relief from
Abuse/Neglect/Exploitation
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

ffidavit in Support of Request for Emergency Relief (Vermont Judiciary)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 30 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document