100-00247 - Complaint for Order Against Stalking or Sexual Assault (07/2016) Page 1 of 2 STATE OF VERMONT SUPERIOR COURT CIVIL DIVISION Unit Docket No. Plaintiff(s) Defendant(s) vs. Complaint for Order Against Stalking or Sexual Assault Plaintiff’s Information: Name: __________________________________________ Date of Birth: _______________________ Name(s) of minor child(ren): _____________________ _______________________ _____________________ _______________________ Defendant’s Information: Name: __________________________________________ Date of Birth: _______________________ Address: ______________________________________________________________________________ Relationship of the Parties: ☐ Married to each other ☐ Live in same residence (current or past) ☐ Divorced from each other ☐ Sexual relationship (current or past) ☐ Dating each other (current or past) ☐ Other (describe relationship) ___________________________________________________________ ☐ Family members (describe relationship) __________________________________________________ Other Civil/Probate/Juvenile/Criminal Court Proceedings or Orders Involving These Parties : Proceeding: ☐ Pending Order ☐ Existing Order Name of Court: County: _________________ State: _____________ Attorney: _____________________________ I. STALKING ☐ On more than one occasion, on or about __________________ and ___________________, the Defendant purposefully did one or more of the following to: ☐ Plaintiff ☐ Plaintiff’s child(ren): ☐ followed, monitored, or surveilled ☐ threatened or made threats ☐ interfered with property II. SEXUAL ASSAULT ☐ 1. On or about ______________________, the Defendant sexually assaulted the Plaintiff or the Plaintiff's child(ren) by doing one or more of the following: ☐ lewd and lascivious conduct ☐ lewd and lascivious conduct with a child ☐ sexual assault ☐ aggravated sexual assault ☐ use of a child in a sexual performance ☐ consenting to a sexual performance and Plaintiff was the victim of the offense