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Vermont Financial Affidavit: Income and Expenses Form

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Vermont Financial Affidavit: Income and Expenses Form
Vermont Financial Affidavit: Income and Expenses Form
STATE OF VERMONT
FAMILY DIVISION
SUPERIOR COURT
Docket No.
Unit
Defendant
Plaintiff
Name
Name
DOB
DOB
V.
FORM 813 A - FINANCIAL AFFIDAVIT
I am: (Please check appropriate box)
Plaintiff
Defendant
Other
INSTRUCTIONS: You are required to complete and file the 813A if-
1. You are a party in a newly filed divorce, civil union dissolution, legal separation, annulment or parentage action and
you and the other party have minor children; OR
2. You or the other party are seeking to modify a previously issued order regarding child support or spousal
maintenance (alimony); OR
3. You are the person required to pay support, and an enforcement action has been filed against you; OR
4. Your child is in the custody of the Department of Children and Families and support has been requested of you; OR
5. You are ordered by the Court to complete and file this form or the other party requests that you fill out the form as
part of the discovery process.
DEADLINE FOR FILING: This form must be filed with the court before or at your first case manager's conference. If
no conference is scheduled it must be filed at least five days before your first scheduled court hearing.
YOU MUST SEND A COPY OF YOUR COMPLETED FORM TO THE OTHER PARTY AT THE SAME TIME
THAT YOU FILE IT WITH THE COURT.
When you have completed the form and filled in all the required information, you must sign the Affirmation section
below and have your signature notarized.
AFFIRMATION
I have read and filled in all the information requested.
I hereby affirm of my own knowledge that the facts and financial information I have stated are true and correct as of the
date of this Affirmation and that I am not omitting any source or amount of income or other information requested on
this form. I understand that any false information may constitute perjury by me. I also understand that if I fail to
provide the required information or give misinformation, the judge may order sanctions against me.
Sworn to me on
,20
/ /,20
My Commission Expires:
Notary Public
1
10/10 SML
Signature of person making affidavit
My Name and Address:
Street
Name
/ / / /
State
Zip
Town/City
Vermont Financial Affidavit: Income and Expenses Form
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