Vermont Motion & Affidavit for Default Judgment Form
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Form 806

STATE OF VERMONT
SUPERIOR COURT
Unit

FAMILY DIVISION
Docket No.

Plaintiff

Defendant

Name

DOB

Name

DOB

v.

MOTION FOR DEFAULT JUDGMENT
Under oath, I, _______________________________, state that the
Print Name

facts are true on information and belief:
1. I filed this action with the court on _________________________.
Date of filing

2. Defendant was served with the summons, complaint and all other
paperwork related to the filing of this case on ________________. An
acceptance of service
Date of service

or a return of service has been filed with the court.
3. Defendant has not filed an answer and it has been at least 20 days since the
date on which s/he was served.
4. Defendant is not in the military service.
5. Defendant is not a minor (under 18 years of age).
6. Defendant is not incompetent.
I hereby swear or affirm that the information above is true to the best of my
knowledge and belief.
Date

Signature
Please Print Name

Signed and sworn to before me:
Date

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