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THE STATE OF NEW HAMPSHIRE (State of New Hampshire)

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File type: PDF

U.S.A. forms for State of New Hampshire

BROWSE STATE OF NEW HAMPSHIRE (NH) FORMS

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NHJB-2057-F (04/30/2021) Page 1 of 4
1. Petitioner Name
Date of Birth E-mail Address
Residence Address
Mailing Address (if different)
Telephone (Cell) (Home) (Work)
2. Respondent Name
Date of Birth E-mail Address
Residence Address
Mailing Address (if different)
Telephone (Cell) (Home) (Work)
3. City and State where parties were married
Date of Marriage
4. Length of time petitioner has been a resident of New Hampshire:
5. List minor children born to or adopted by the parties either before or during the marriage:
Name Date of Birth Current Address
If there are minor children born to or adopted by the parties either before or during the
marriage, complete questions 6 – 10. This information is required under RSA 458-A, the
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA).
It is important that you answer these questions with as much detail and accuracy as possible. Lack of
adequate information could significantly delay orders being issued in your case.
There are several situations that might result in New Hampshire exercising jurisdiction over child/ren.
The continuous presence of the child/ren in New Hampshire for six (6) months is not the only basis
for jurisdiction. In some emergency situations, the court may be able to exercise jurisdiction on a
temporary basis.
THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
htt
p
://www.courts.state.nh.us
Court Name:
Case Name:
Case Number:
(if known)
PETITION FOR DIVORCE
Clear Form
Top of Page
Case Name:
Case Number:
PETITION FOR DIVORCE
NHJB-2057-F (04/30/2021) Page 2 of 4
6. List the places where the minor child/ren of the parties has/have lived in the last five (5) years
and the names of the people they lived with at that time, if you know. Start with where the child lives
now and work backward in time.
Dates
From/To
Town/City, State Parent(s)/Caretaker Current Address/Contact
Address of Parent/Caretaker
Which
Child/ren
If more space is needed, attach Extra Page (NHJB-2656-FP).
I have attached Form NHJB-2656-FP because additional space was needed.
7. Are there any person(s), not a party to this proceeding, who have physical custody of the child/ren
or who claim to have custody, physical custody or parenting time rights? Yes No
If yes, list name(s) and address(es) of person(s):
8. Check one of the following:
I have not participated in any court case(s) concerning the custody, visitation, parenting time
or placement of the child/ren in this or any other state.
OR
I have participated in court case(s) concerning the custody, visitation, parenting time or
placement of the child/ren in this or any other state. I have participated in the following:
Name of Court State Case No. Date of Court Order
9. Are there any actions for enforcement, or proceedings relating to domestic violence, domestic
relations, protective orders, marriage dissolution, paternity, legitimation, custody, parental rights and
responsibilities, termination of parental rights, adoption, juvenile, or other proceedings in any court in
any state affecting any children named in this petition or parents of those children? Yes No
If yes, complete the following:
Name of Court State Case No. Type of Court Case
Top of 1st Page
Case Name:
Case Number:
PETITION FOR DIVORCE
NHJB-2057-F (04/30/2021) Page 3 of 4
10. Optional: I am alleging, under oath, that my or my child/ren’s health, safety, or liberty would be
jeopardized by the disclosure of identifying information set forth in this Petition. To support my
allegation, I state as follows:
11. Please check one of the following regarding public assistance.
No public assistance (TANF) is now being or has within the last 6 months been provided, nor is
medical assistance (Medicaid) presently being provided, for any minor child of the parties.
The N. H. Department of Health and Human Services is providing or has provided within the
last 6 months public assistance (TANF) and/or medical assistance (Medicaid) for a minor child or
children of the parties. If you check this box, you must mail copies of this petition and the
Personal Data Sheet (NHJB-2077-F) to DHHS at:
New Hampshire Department of Health and Human Services
Bureau of Child Support Services - Legal Unit
129 Pleasant Street
Concord, NH 03301
12. To the knowledge of the parties, is either party pregnant? Yes No
13. Do the parties own real estate jointly? Yes No
Does the petitioner own real estate individually? Yes No
Does the respondent own real estate individually? Yes No
14. The cause for divorce is: (Check one or both)
Irreconcilable differences have developed that have caused the irremediable breakdown of the
marriage.
Other:
15. Requests for court orders:
A. TEMPORARY. The Petitioner respectfully requests that the Court issue temporary orders on
any of the following issues. (check all that apply). A temporary order is in effect until the
divorce is granted.
Child support Parenting Plan Use of personal property and payment of debt
Alimony Use of family home Other:
B. FINAL. The Petitioner respectfully requests that the Court grant a divorce, equitably divide
personal property, real estate, debts and obligations of the parties, and issue a final order
approving or establishing the following (check all that apply):
A parenting plan which describes the parties’ parental rights and responsibilities relating to
minor children;
Child support obligations for any minor children;
Alimony;
Any other relief which may be appropriate;
Other:
Top of 1st Page
Case Name:
Case Number:
PETITION FOR DIVORCE
NHJB-2057-F (04/30/2021) Page 4 of 4
I acknowledge that I have a continuing duty to inform the court of any court action in this or
any other state that could affect the child/ren in this case.
I swear or affirm that the foregoing information is true and correct to the best of my knowledge.
Date Signature of Petitioner
State of , County of
This instrument was acknowledged before me on by
My Commission Expires
Affix Seal, if any Signature of Notarial Officer / Title
Signature of Attorney for Petitioner
Printed Name, Address and Phone Number of Attorney Bar #
Top of 1st Page
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THE STATE OF NEW HAMPSHIRE (State of New Hampshire)

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Completed 16 December 2021

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