Form Nhjb 2061 Fs – Fill Out and Use This PDF

THE STATE OF NEW HAMPSHIRE

JUDICIAL BRANCH

http://www.courts.state.nh.us

Court Name:

Case Name:

Case Number:

(if known)

PARENTING PETITION

This form replaces the former “Petition for Custody”

1.

Petitioner Name

Relationship to Child

Date of Birth

E-mail Address (optional)

Residence Address

Mailing Address (if different)

Telephone Number (Home)

(Work)

2.

Respondent Name

Relationship to Child

Date of Birth

E-mail Address (optional)

Residence Address

Mailing Address (if different)

Telephone Number (Home)

(Work)

3.Length of time petitioner has been a resident of New Hampshire Length of time child(ren) has resided in New Hampshire

4.List minor children born to or adopted by the parties:

Questions 5 – 9 are 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.

NHJB-2061-FS (12/01/2010)

Page 1 of 3

Case Name:

Case Number:

PARENTING PETITION

5.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.

If more space is needed, attach Extra Page (Form NHJB-2656-FPS).

I have attached Form NHJB-2656-FPS because additional space was needed.

6. 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):

7. 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:

8.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:

NHJB-2061-FS (12/01/2010)

Page 2 of 3

Case Name:

Case Number:

PARENTING PETITION

9. 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:

10. 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-FS) to DHHS at:

New Hampshire Department of Health and Human Services

Division of Child Support Services - Legal Unit

129 Pleasant Street

Concord, NH 03301

11.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 final hearing.

B.FINAL. The Petitioner respectfully requests that the Court 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;

Any other relief which may be appropriate;

Other:

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 #

NHJB-2061-FS (12/01/2010)

Page 3 of 3