Complaint For Legal Separation Form Page 2
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4COMPLAINT FOR LEGAL SEPARATION
FACTS
The Plaintiff states that the following facts are true:
1.
Residence:
(A)
I am now a resident of ________________________, ____________________ .
County
State
I have resided in Vermont for 6 full months.
(B)
Defendant is now a resident of ________________, ______________________.
County
State
Defendant has resided in Vermont for 6 full months.
2.
Marriage: We were married at (city) ___________________________,
(state)___________________________ on (month, date, year) _____________________
and are still married.
3.
Grounds: The reason I am asking for a legal separation:
Six Month Separation: We have or will have lived separate and apart for more than
six (6) consecutive months and it is not reasonably probable that we can resume our
marital relationship.
My spouse and I separated on (month, day, year): ________________.
Other: (Please explain) ______________________________________________
4.
Minor Children of the parties:
We have children of our marriage who are either younger than 18 years old, or are
18 years old and still in high school. Include born or adopted children.
Name of Child
DOB
Name of Child
DOB
Name of Child
DOB
Name of Child
DOB
Name of Child
DOB
Name of Child
DOB
5.
UCCJA Jurisdiction: Information required under 15 V.S.A. § 1037
(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 started and list all
addresses for the past five years.)
Address
Dates
Names of all persons living in the
Include street, city and state
From when to
household with the child
when
Use an additional page if you need more space. If children have lived at different addresses
from each other please indicate the addresses for each child.
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