Nh Petition Guardianship Form – Fill Out and Use This PDF

Enter the Court Name, the Case Name and the Case Number (if known).

Guardianship is requested for: Person, Estate or Person and Estate.

Enter the Petitioner name, Relationship to minor, Mailing address (Street, City, State, Zip code), Telephone and E-mail.

Enter the Attorney name, Telephone, Firm name, Bar ID # and Mailing address (Street, City, State, Zip code).

Yes or No: The minor is the age of fourteen years or older.

Enter the Minor's legal name, Date of birth and Mailing address (Street, City, State, Zip code).

Information about the minor's parents: for Parent A and Parent B, enter the name, Date of birth, Mailing address (Street, City, State, Zip code), Telephone and E-mail.

Enter the Proposed guardian name, Date of birth, Relationship to minor, Occupation, Mailing address (Street, City, State, Zip code), Telephone and E-mail.

Questions 9 - 14 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.

9. List the places where the minor child has 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. Enter Dates From/To, Town/City, State, Parent(s)/Caretaker and Current Address/Contact Address.

Yes or No: Are there any person(s), not a party to this proceeding, who have physical custody of the child or who claim to have custody, physical custody or parenting time rights? If yes, list name(s) and address(es) of person(s): Name, Current Address.

11. Check one of the following.

Have not participated in any court case(s) concerning the custody, visitation, parenting time or placement of the child in this or any other state, OR have participated in court case(s) concerning the custody, visitation, parenting time or placement of the child in this or any other state. If participated, enter Name of Court, State, Case No. and Date of Court Order.

Yes or No: 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 this child named in this petition or parents of the child? If yes, complete the following:

Name of Court, State, Case No. and Type of Court Case.

13. List the names and addresses of any persons having the principal care and custody of the minor during the 60 days preceding the filing of this petition: Name, Relationship to minor and Mailing address (Street, City, State, Zip code).

14. This question is optional. You may skip this question if it does not apply to your circumstance.

NOTE: If you complete this question, you will be required to print, notarize and upload this Petition before submitting it to the Court.

I am alleging, under oath, that this minor's or my health, safety, or liberty would be jeopardized by the disclosure of certain identifying information set forth in this Petition. To support my allegation, I state as follows:

The answers on this Petition that I do not want to disclose are: (Check all that apply)

Yes or No: Is this an Ex Parte request? If yes, petitioner must complete the Ex Parte (Emergency) Motion form

Yes or No: Are there any adults, other than the proposed guardian, who will be living in the same home as the minor? If yes, provide their name(s). If yes, you must provide the court with a completed Criminal Record Release Authorization form and a DHHS Record Release Authorization form for each of those adults within 10 days of the filing of this petition.

Yes, No or Unknown: Are there any pending adoption, juvenile, domestic violence, marriage dissolution, domestic relations, paternity, legitimation, custody or other proceedings affecting minor or parents of this minor? (If yes, attach a separate sheet identifying and explaining each.)

Yes, No or Unknown: Is an adoption of the minor by the proposed guardian(s) contemplated? Is the minor entitled to receive local, state or federal benefits and/or entitlements?

Yes, No or Unknown: Is there an existing child support order for this child? If yes, is support collected by the Bureau of Child Support Services? If no, are you seeking a child support order as part of this guardianship?

Yes, No or Unknown: Is there an existing court visitation order or custody order for this child? If yes, attach a copy of that order to this petition.

Yes, No or Unknown: Is there any reason that this child should not visit with his/her parents? If yes, state clearly and specifically any reason(s). Attach a separate sheet if needed.

Yes, No or Unknown: Is this guardianship being sought by the Department of Health and Human Services as part of a permanency plan pursuant to the Adoption and Safe Families Act of 1997?

27. Guardianship requested: temporary or not temporary/enduring. 28. As required by RSA 463:5, V, a statement must be included describing specific facts concerning actions or omissions or actual incidents involving the minor which are claimed to demonstrate that guardianship is in the best interests of the minor.

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 named in this petition, and will do so, and I understand the court may search for and review any case involving this child.

Verification: I verify the truth and accuracy of all facts alleged within this document to the best of my belief and further verify that all facts contained in this document are alleged in good faith.

By affixing my electronic signature to this document I acknowledge my understanding that any false statements made in this document are punishable as perjury which may include a fine or imprisonment or both.

Enter the Name of Filer, Signature of Filer (/s/) and Date, then the Law Firm, if applicable, Bar ID # of attorney, Telephone, Address, E-mail, City, State and Zip code.