Domestic Violence Protection Order - Vermont

IMPORTANT: THIS IS A PREPARATION GUIDE — NOT THE OFFICIAL COURT FORM

Vermont requires the use of official court form 400-00150C (Complaint for Relief from
Abuse) for domestic violence protection order petitions. This template provides the
substantive legal content to help you prepare — but you must transfer your content to the
official form before filing. The official form is available at
https://www.vermontjudiciary.org/family/relief-abuse.
Do not file this document directly with the court.

VERMONT SUPERIOR COURT — FAMILY DIVISION

DOMESTIC VIOLENCE PROTECTION ORDER

(a/k/a “Relief-From-Abuse Order” under 15 V.S.A. § 1101 et seq.)

Case No.: [DOCKET NUMBER]
County: [COUNTY]
Division: Family

Petitioner (Protected Party): [PETITIONER FULL LEGAL NAME]
Respondent (Restrained Party): [RESPONDENT FULL LEGAL NAME]

Effective as of [EFFECTIVE DATE] (“Effective Date”)
Expires on [EXPIRATION DATE – fixed period set by the Court; extendable on the plaintiff's motion under 15 V.S.A. § 1103(e)]

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block

I. DOCUMENT HEADER

1. Recitals
   1.1 On [FILING DATE], Petitioner filed a sworn Complaint/Petition for Relief-From-Abuse pursuant to 15 V.S.A. § 1103.
   1.2 The Court, having reviewed the pleadings, evidence, and testimony, makes the findings below and issues this Domestic Violence Protection Order (“Order”).
   1.3 Jurisdiction and venue are proper in this Court under Vermont law.

2. Consideration
   2.1 No contractual consideration is required; this Order is issued pursuant to statutory authority and the Court’s equitable powers.

II. DEFINITIONS

For purposes of this Order:

“Abuse” means conduct defined in 15 V.S.A. § 1101(1) (including attempting to cause or causing physical harm, placing another in fear of imminent serious physical harm, abuse to children, stalking, sexual assault, and coercive controlling behavior).

“Contact” includes in-person, telephone, text, email, social media, third-party, or any other direct or indirect communication.

“Court” means the Vermont Family Division of the Superior Court issuing this Order.

“Firearm” has the meaning set forth in 18 U.S.C. § 921(a)(3).

“Protected Address” means [STREET ADDRESS OR ‘ANYPLACE PETITIONER MAY RESIDE OR BE PRESENT’].

“Protected Parties” means Petitioner and the following minors or household members: [LIST FULL NAMES & DOBs].

“Respondent” means [RESPONDENT FULL LEGAL NAME & DOB].

III. OPERATIVE PROVISIONS

1. Prohibited Conduct
   1.1 Respondent SHALL NOT abuse, harass, stalk, threaten, intimidate, or interfere with the personal liberty of any Protected Party.
   1.2 Respondent SHALL NOT contact any Protected Party, directly or indirectly, except as expressly permitted in Section III.4.

2. Stay-Away Requirement
   2.1 Respondent SHALL remain at least [100 feet] (or other Court-specified distance) from any Protected Party, the Protected Address, place of employment, school, childcare, or any other location where a Protected Party is known to be.
   2.2 Lawful brief contact through counsel in active litigation is excepted.

3. Exclusive Possession of Residence
   3.1 Petitioner is awarded exclusive temporary possession of the residence located at [ADDRESS].
   3.2 Law enforcement SHALL assist in the orderly removal of Respondent’s personal effects within [X] hours of service of this Order, if requested.

4. Limited Communication for Parenting Time (if applicable)
   4.1 Except for communication strictly necessary to effectuate parenting time or exchanges of the minor child(ren) [NAMES], all contact is prohibited.
   4.2 Communication shall occur only via [COURT-APPROVED APP / EMAIL / THIRD-PARTY] and solely regarding the child(ren).
   4.3 Exchange location: [POLICE STATION / SUPERVISED CENTER].

5. Temporary Custody & Support (if sought and granted)
   5.1 Petitioner is awarded temporary sole legal and physical custody of [CHILDREN NAMES].
   5.2 Respondent shall pay temporary child/spousal support in the amount of $[AMOUNT] per [WEEK/MONTH], beginning [DATE], per Vermont Child Support Guidelines. A support order under a relief-from-abuse proceeding is for a period not to exceed three months unless the proceeding is consolidated with a divorce, separation, or parentage action (15 V.S.A. § 1103(c)(2)(E)–(F)).

6. Firearms, Dangerous Weapons, and Licenses
   6.1 Vermont does not automatically bar every relief-from-abuse respondent from possessing firearms; however, upon appropriate findings the Court may order Respondent to relinquish firearms and prohibit their possession as relief necessary to protect the Protected Parties (15 V.S.A. § 1103(c); § 1104(a)(1)(E)). [If the Court so orders:] upon service of this Order, Respondent shall immediately relinquish all Firearms, ammunition, and dangerous weapons in Respondent’s possession, custody, or control to a cooperating law enforcement agency or an approved federally licensed firearms dealer (or, if the Court directs, to an approved third party), as required by 20 V.S.A. § 2307(b). Independent of any state order, federal law (18 U.S.C. § 922(g)(8)) prohibits firearm possession by a person subject to a qualifying protective order entered after notice and hearing.
   6.2 Law enforcement is authorized to accompany Respondent to facilitate any ordered surrender.

7. Mental-Health / Substance-Abuse Conditions (if ordered)
   7.1 Respondent SHALL undergo [EVALUATION / COUNSELING] at [FACILITY] and provide proof of enrollment within [X DAYS].

8. Duration
   8.1 This Order remains in full force until the Expiration Date unless modified, extended, or vacated by further Court order (15 V.S.A. § 1103(e)).

IV. REPRESENTATIONS & WARRANTIES

1. Jurisdiction & Service
   1.1 The Court finds it has subject-matter jurisdiction and personal jurisdiction over the parties.
   1.2 Respondent was personally served or had actual notice of the hearing in compliance with the Vermont Rules for Family Proceedings governing abuse prevention (V.R.F.P. 9).

2. Findings of Abuse
   2.1 Based on a preponderance of evidence, the Court finds Respondent committed Abuse against Petitioner, satisfying the statutory predicate for relief (15 V.S.A. § 1103(b)–(c)).

3. Disclosure of Firearms
   3.1 Respondent represents under oath that all Firearms and permits have been fully disclosed to the Court.

V. COVENANTS & RESTRICTIONS

1. Affirmative Covenants of Respondent
   (a) Obey all terms herein and any subsequent enforcement directives of law enforcement.
   (b) Appear at all scheduled review hearings.
   (c) Notify the Court in writing within 24 hours of any change of address or telephone number.

2. Negative Covenants of Respondent
   (a) If the Court has prohibited firearm possession (see Section III.6) or if 18 U.S.C. § 922(g)(8) applies, do not possess, purchase, or attempt to purchase Firearms or ammunition during the pendency of this Order.
   (b) Do not remove minor child(ren) from Vermont without written Court permission.

VI. DEFAULT & REMEDIES

1. Events of Default
   1.1 Any violation of Sections III–V constitutes an “Event of Default.”

2. Notice & Cure
   2.1 No notice or cure period is required; violations are subject to immediate civil or criminal enforcement.

3. Graduated Remedies
   (a) Civil contempt proceedings;
   (b) Criminal prosecution for violation of an abuse prevention order (13 V.S.A. § 1030), and/or criminal contempt (15 V.S.A. § 1108(e));
   (c) Arrest by law enforcement to enforce this Order under 15 V.S.A. § 1108(a) (in accordance with V.R.Cr.P. 3);
   (d) Extension of this Order for additional fixed periods upon the plaintiff’s motion (15 V.S.A. § 1103(e)); the Court need not find that new abuse occurred during the pendency of the Order to extend it.

4. Attorney’s Fees & Costs
   4.1 The prevailing party in any contempt or enforcement action may recover reasonable attorney’s fees and costs.

VII. RISK ALLOCATION

1. Indemnification
   1.1 Not applicable to this judicial Order.

2. Limitation of Liability
   2.1 Nothing herein imposes civil liability upon Petitioner for actions taken by law enforcement pursuant to this Order.

3. Force Majeure
   3.1 Not applicable.

VIII. DISPUTE RESOLUTION

1. Governing Law
   1.1 This Order is governed by Vermont’s Relief-From-Abuse Statute, 15 V.S.A. § 1101 et seq., and related rules.

2. Forum Selection
   2.1 Exclusive jurisdiction for modification, enforcement, or contempt lies with the Vermont Family Division, [COUNTY].

3. Arbitration & Jury Trial
   3.1 Arbitration is unavailable.
   3.2 Jury trial is not available in relief-from-abuse proceedings.

4. Injunctive Relief
   4.1 The equitable injunctive relief granted herein is the primary remedy; all criminal remedies are concurrent.

IX. GENERAL PROVISIONS

1. Amendment & Waiver
   1.1 Only the Court may amend, vacate, or dismiss this Order. Oral modifications are VOID. The Court may modify the Order at any time on motion by either party and a showing of a substantial change in circumstances (15 V.S.A. § 1103(e)).
   1.2 Waiver by Petitioner of any violation is ineffective unless the Court so orders.

2. Assignment
   2.1 Rights conferred upon Protected Parties are personal and non-assignable.

3. Severability
   3.1 If any provision is held invalid, the remainder shall remain enforceable.

4. Integration
   4.1 This Order, together with any attachments (Firearms Surrender Order, Parenting Plan, Support Order), constitutes the entire relief granted.

5. Service & Entry
   5.1 The Clerk SHALL transmit copies to:
   (a) Petitioner;
   (b) Respondent;
   (c) [LOCAL POLICE DEPARTMENT];
   (d) the Department of Public Safety abuse prevention database (15 V.S.A. § 1107).
   5.2 Proof of service SHALL be filed within [X] days.

6. Electronic Signatures
   6.1 Consistent with the Vermont Rules for Electronic Filing, this Order may be signed electronically and shall have the same force as an original.

X. EXECUTION BLOCK

Issued at [CITY], Vermont on [DATE].

_______________________________
[JUDGE NAME], Superior Court Judge
Vermont Superior Court, Family Division

ATTEST:
_______________________________
[CLERK NAME], Docket Clerk

ACKNOWLEDGMENT OF RECEIPT BY RESPONDENT
I, [RESPONDENT NAME], acknowledge personal service of this Order and understand its terms and the penalties for violation.

Signature: __________________ Date: ___________

NOTARIZATION (if locally required)
State of Vermont, County of [COUNTY], ss.
Subscribed and sworn before me on [DATE].
______________________________
Notary Public
My Commission Expires: _____________