Affidavit: Relief From Abuse
STATE OF VERMONT
City, State, Zip
Defendant's Street Address
AFFIDAVIT IN SUPPORT OF COMPLAINT
In support of the claims made in my complaint and subject to the penalties for perjury, I state the following facts to be
true to the best of my knowledge and belief.
1. The most recent incident that causes me to ask for an order happened on or about
Name of person
did the following to me and/or the
(Describe what happened below. Be specific: What was the act or threat of violence? Where did it happen? Who else was there? Was a weapon
involved? Were you or anyone else injured? What were the injuries?)
Attach a separate sheet if necessary
2. Is the incident described above the most serious incident involving the defendant?
If your answer is No, please fill in th