Family Division

Juvenile Delinquency / CHINS

Form Number	Name of Form	Description	Associated Forms
NHJB-2184-DF	Juvenile Petition	This form is used set forth an allegation of juvenile delinquency or Child in Need of Services (CHINS). It includes a notice of hearing to be completed by the court at the bottom of the form, and, on the second page, a statement of rights and financial obligations.
NHJB-2213-DF	Juvenile Waiver of Counsel	Form completed by juvenile and parent/guardian/custodian when juvenile waives his or her right to counsel.
NHJB-2216-DF	Agreement to Waive Initial Time Limits Delinquent CHINS	Form used by parties to waive time limits in delinquent or CHINS cases.
NHJB-2217-DF	Delinquency Acknowledgment and Waiver of Rights	Form completed by juvenile and parent/guardian/custodian when juvenile waives his or her rights upon admitting the truth of the acts in the delinquent petition.
NHJB-2218-DF	CHINS Acknowledgment and Waiver of Rights	Form completed by juvenile and parent acknowledging rights being waived when pleading true in a CHINS case.
NHJB-2227-DF	Juvenile Return of Service	Used by law enforcement to inform the court how, when, and upon whom the juvenile petition was served.
NHJB-2252-DF	Juvenile Acknowledgment and Waiver of Right to Jury Trial	Form completed by juvenile and parent/guardian/custodian when juvenile waives right to a jury trial.
NHJB-2353-DF	Acknowledgment of License Penalty	Form completed by juvenile, which judge then reviews with the juvenile, indicating his/her understanding of the license penalty resulting from conviction of the offense.
NHJB-2354-DF	Juvenile Diversion Agreement	Form in which parties to a juvenile case agree that the juvenile will enter a diversion program and explain the terms of the diversion agreement.
NHJB-2355-DF	Notification of Parental Responsibility in Delinquency Case	Form completed by the parents or the guardians of a juvenile in which they acknowledge their parental responsibilities in a delinquency case. Once completed, the judge reviews the form with the parents or guardians.
NHJB-2438-DF	Contrary to Welfare and/or Reasonable Efforts Order Del/CHINS	This form is used by judges at certain hearings in CHINS or Delinquency cases. It in necessitated by the passage of SB 152, codified in RSA 169-B and D.
NHJB-2440-F	Notice of Intent to Disclose Del/CHINS Records	The purpose of this form is to have a standard notice form that school districts file when they want to disclose any court records related to a CHINS or delinquency proceeding to a hearing officer in an special education administrative due process hearing at the Department of Education per RSA 169-B:22, IV and RSA 169-D:18, IV.
NHJB-2581-DF	Detention Assessment Screening Instrument	This is the screening instrument which all JPPOs, police departments, prosecutors and judges, are required to complete when detention of a juvenile is contemplated in a juvenile delinquency case.	Instructions

Juvenile Abuse and Neglect

Form Number	Name of Form	Description	Associated Forms
NHJB-2113-DF	Petition for Abuse / Neglect	Form used to set forth an allegation of abuse or neglect of a child.
NHJB-2135-DF	Petition to Expunge	Filed by a person who is seeking to remove his/her name from DCYF's central registry of founded reports of abuse and/or neglect.
NHJB-2192-DF	Notice to Accused Parent	Distributed to a parent accused of Abuse or Neglect, explaining the court process and the parent’s rights.
NHJB-2209-DF	Acknowledgment of Possible Consequences to Parental Rights in Abuse and Neglect Cases	Form to be reviewed and signed by parents at the preliminary hearing in an abuse or neglect case.
NHJB-2231-DF	Notice to Non-accused Parent who is a Household Member	Distributed to a parent who is not accused of abuse or neglect but is a member of the same household as the parent who is accused, explaining the court process and the parent’s rights.
NHJB-2232-DF	Notice to Non-accused, Non-household Parent	When one parent is accused of abuse or neglect, this form is distributed to the other parent when that other parent is not accused of abuse or neglect and does not live in the same household as the accused parent. This form explaining the court process and the non-accused, non-household parent’s rights.
NHJB-2233-DF	Right to an Attorney in an Abuse or Neglect Case, Request for Court-Appointed Attorney or Waiver of Right to an Attorney	Form distributed to parent accused of abuse or neglect explaining right to an attorney. Parent completes form by indicating that s/he intends to hire an attorney or request court-appointed counsel or waive his or her right to an attorney.
NHJB-2258-DF	The Effect of a Consent Order without a Finding	Completed by parent in abuse / neglect case to acknowledge the effect of a consent order without a finding.
NHJB-2270-DF	The Effect of a Consent Order on your Constitutionally and Statutorily Protected Rights, including your Parental Rights	Completed by parent in abuse / neglect case to acknowledge the effect of a consent order.
NHJB-2276-F	Motion to Close All or Portions of Abuse / Neglect Hearing	Filed by party seeking to have abuse or neglect hearing closed to the public.
NHJB-2350-F	Notice of Pilot Project relative to Abuse / Neglect Hearings	Notice distributed to parties in Abuse / Neglect cases, informing them of the pilot project allowing open abuse / neglect hearings.
NHJB-2439-F	Order on Extraordinary Circumstances	This order is required if an abuse/neglect case is unable to be scheduled and completed within 30 calendar days of the filing of the petition. If the judge finds extraordinary circumstances, the case must be scheduled, completed, and order issued within 60 calendar days of the filing of the petition.
NHJB-2441-F	Pre-Trial Conference Order	This order is completed if a Pretrial Conference is scheduled/held in an abuse/neglect case.
NHJB-2493-F	Motion to Disclose Child A/N Court Records	The purpose of this form is to have a standard motion form that school districts file when they want to disclose any court records related to a child abuse and neglect proceeding to a hearing officer in an special education administrative due process hearing at the Department of Education per RSA 169-C:20, IV.
NHJB-2533-F	Notification to Dept of ED of Educational Surrogate Parent Appt	The purpose of this form is to have a standard notice that the court provides to the Department of Education when the court orders an educational surrogate parent for a child with a disability, pursuant to RSA 186-C:14, III.
NHJB-2542-DF	Notice of Intent to Mediate
NHJB-2543-DF	Agreement to Participate in Mediation

Adoption

Form Number	Name of Form	Description	Associated Forms
NHJB-2080-FP	Surrender of Parental Rights	Any parent voluntarily surrendering their parental rights must complete this form. It specifies the rights being surrendered.
NHJB-2081-FP	Dept of Health and Human Services or Agency Surrender of Parental Rights	If the department of health and human services or a child-placing agency has through court action or parental surrender been given case, custody and control of an adoptee, the department or agency must complete this form to surrender their rights to the adoptee. The form specifies the rights being surrendered.
NHJB-2171-FP	Department of Health and Human Services Record Release Authorization	Required in minor guardianship and some adoption cases when completing background checks on the proposed guardians or adoptive parents.
NHJB-2179-FP	Agreement to Mediate	Form used to describe the mediation process and used at the beginning of a mediation session. This form is used internally but posted on the website so those participating in mediation may review it ahead of time and better understand the mediation process.
NHJB-2185-FP	Petition for Adoption	This petition is the primary form filed in the adoption of either a minor child or adult, although other documents as well as an original birth certificate of the child are also required.
NHJB-2188-FP	Petition for Termination of Parental Rights	This form is filed with the court to begin the process of terminating a parent-child relationship. The possible reasons or grounds for terminating the parent’s rights are listed on the form.
NHJB-2189-FP	Affidavit of Mother	This form must be completed by the birth mother surrendering her parental rights. It is intended to identify the father of the child.
NHJB-2190-FP	Interstate Adoption Putative Father Registry Information	RSA 170-B:6 requires the person filing a petition for an interstate adoption to also file this form with the court to tell the court the name and location of the putative father registry in the state where the child was born.
NHJB-2191-FP	Petition for Validation of Adoption Finalized in a Foreign Country	If an adoption has been finalized in another country, the adoptive parent may be able to file this petition to ask the court to validate the adoption in NH.
NHJB-2193-FP	Medical Information on Birth Parents	This form is filed in an adoption proceeding to provided non-identifying medical background information on the birth parents.
NHJB-2194-FP	Notice of Intent to Claim Paternity and Request for Hearing	This form must be filed by an alleged father to give the court notice of his intent to claim paternity of a child in an adoption case, and to request a hearing on that paternity claim.
NHJB-2302-FP	Voluntarily Mediated Agreement	In adoptions involving a child who is under either the legal custody or guardianship of the department of health and human services, a voluntary mediation may be held to reach a voluntarily mediated agreement regarding the permanent placement of the child. This form will be used for that purpose.
NHJB-2392-F	Adoption Mediation Report	This form is completed by the probate mediator following the voluntary mediated adoption session. The form guides the court in scheduling the next event in the case.
VS-37	Vital Records Report (Adoption)	Required in all adoptions. This form is also available from Vital Records Administration	Contact Vital Records for information (603) 271-4650

Guardianship

Form Number	Name of Form	Description	Associated Forms
NHJB-2024-F	Petition for Guardianship of Minor (Person Only)	To be completed by party seeking guardianship over the person of a minor.
NHJB-2025-F	Motion to Terminate Guardianship	Filed with the court to request that a guardianship be terminated
NHJB-2170-FP	Report of the Guardian of the Person – Minor	RSA 463 requires that the guardian of a minor child under guardianship file a report 6 months after appointment and then annually each year to report on the general status of that child. This form serves as that report.

Name Change

Form Number	Name of Form	Description	Associated Forms
NHJB-2319-F	Petition for Name Change relating to Family Division Jurisdiction	This form is filed by a party seeking to change the name of an adult or a minor child. The name change must be related to Family Division jurisdiction, otherwise the name change must be filed in Probate Court.
NHJB-2320-F	Name Change Affirmation	This form must be submitted by the party seeking to change their name or the name of a minor child in Family Division, in order to inform the court of certain factors that may impact the request for name change.
NHJB-2321-F	Name Change Information Sheet	This form is given to parties seeking a name change to inform them of the name change process and their responsibilities following a change of name.
NHJB-2322-F	Consent to Minor Name Change	This form may be filed with a Petition for Change of Name related to Family Division Jurisdiction, indicating that a non-petitioning parent or guardian agrees to changing the minor child’s name.

Divorce / Parenting

Form Number	Name of Form	Description	Associated Forms
NHJB-2057-FS	Petition for Divorce	Petition to be used for one party to file for divorce.
NHJB-2058-FS	Joint Petition for Divorce	Petition to be used when parties agree to file for divorce together.
NHJB-2059-FS	Petition for Legal Separation	Petition to be used for one party to file for legal separation.
NHJB-2060-FS	Joint Petition for Legal Separation	Petition to be used for parties to file for legal separation together.
NHJB-2061-FS	Parenting Petition	Petition to be used by a party, usually unmarried, seeking to establish parental rights and responsibilities.
NHJB-2062-FS	Petition to Change Court Order	Petition to be used by a party seeking to re-open their case and have the court modify prior orders.
NHJB-2063-FS	Petition to Register Foreign Order	Petition to be used by a party seeking to register an order from another state or jurisdiction.
NHJB-2064-FS	Parenting Plan	This is a form for parties to use in creating their parenting plans. Parenting plans must be filed in any case to establish or modify an order for parental rights and responsibilities, such as a divorce, legal separation, or parenting (formerly “custody”) petition.	Alternate
NHJB-2065-FS	Financial Affidavit	Form used by parties in domestic cases to inform the court and each other of financial information.
NHJB-2066-FS	Uniform Support Order	This form is issued by the court when establishing child support orders.
NHJB-2067-FS	Affidavit of Receipt of Service	To be completed when a party accepts service of a petition.
NHJB-2068-F	Child Impact Program Notice	Notice to parties of requirement to attend Child Impact Seminar.
NHJB-2071-FS	Final Decree on Divorce or Legal Separation	This form provides standard language for a final order on a Divorce or Legal Separation.	Alternate
NHJB-2072-FS	Temporary Decree on Divorce or Legal Separation	This form provides standard language for a temporary order on a Divorce or Legal Separation.	Alternate
NHJB-2073-FS	Scheduling Conference Order	To be completed by court at Scheduling Conference.
NHJB-2074-FS	Pretrial Conference Order	To be completed by court at Pretrial Conference.
NHJB-2076-FS	Ex Parte (Emergency) Motion	To be completed by party seeking Ex Parte order.	Instructions
NHJB-2077-FS	Personal Data Sheet	To be completed by party filing any initial domestic relations petition, or any petition to reopen a domestic case.
NHJB-2078-FS	Decree on Parenting Petition	This form provides standard language for a temporary or final order on a Parenting Petition.	Alternate
NHJB-2101-FS	Child Support Guidelines Worksheet	Completed by parties in divorce or parenting actions to calculate child support.
NHJB-2197-FS	Affidavit of Impossibility	Form filed by party who is unable to obtain a financial affidavit from the other side.
NHJB-2198-FS	Affidavit of Non-Cohabitation	Completed in a divorce action to demonstrate that parties are not living together.
NHJB-2199-FS	Petition for Contempt	Petition filed by a party who asserts that another party is in contempt for failing to follow a court order.
NHJB-2200-DFPS	Affidavit as to Military Service	Form completed to show that defaulting party is or is not in military service.	Instructions
NHJB-2205-F	Request for Certified Copy of Divorce Decree or Vital Statistics	Form filed with the court requesting either a certified copy of divorce decree or vital statistics form. The Vital Statistics Form is required in order to remarry and/or to return to maiden name after divorce, etc.
NHJB-2228-FS	Petition for Grandparent Visitation	To be used when grandparents are seeking visitation with grandchild.
NHJB-2343-F	Motion to be Exempt from Attending Child Impact Program	Filed with a petition when party believes s/he should not have to attend the child impact seminar
NHJB-2345-F	Motion to Waive/Reduce Child Impact Seminar Fee	Filed when a party believes they can't afford the child impact seminar fee and the seminar provider has already denied their fee waiver request.
NHJB-2346-F	Motion to Extend Time to Complete Child Impact Program	Filed when a party believes they need more time to complete Child Impact Program.
NHJB-2356-FS	Affidavit of Notification Compliance	Form filed by party who is seeking ex parte relief, explaining what efforts s/he has made to notify the other party.
NHJB-2390-FS	Joint Parenting Petition	Petition to be used by parties when they jointly seek to establish parental rights and responsibilities.
NHJB-2449-FS	Petition for Civil Union Dissolution	Petition to be used for one party to file for civil union dissolution.
NHJB-2450-FS	Joint Petition for Civil Union Dissolution	Petition to be used when parties agree to file for civil union dissolution together.
VS-14a	Vital Statistics Form	In opposite sex cases, must be completed for divorce, legal separation or annnulment to be final.
VS-14Acu	Vital Statistics Form	In same sex cases, must be completed for dissolution, legal separation or annnulment to be final.

First Appearance / Mediation

Form Number	Name of Form	Description	Associated Forms
NHJB-2052-F	Mediation Participation Agreement	Form completed by parties at beginning of divorce or parenting mediation, setting forth the terms of mediation, including payment.
NHJB-2087-F	Have you considered mediation?	Distributed to parties with Order of Notice, explaining mediation.
NHJB-2091-FS	Mediation Questionnaire	Superior Court and Family Division mediators will give the form to the parties after the mediation is completed so they may complete it and return it to the clerks office in a sealed envelope
NHJB-2324-F	Mediation Report	This form is completed following each mediation session conducted by a court-appointed mediator in a marital or parenting case. The form guides the court in scheduling the next event in that case.
NHJB-2325-F	Important Mediation Information	This form is given to parties, at First Appearance, along with their date for mediation, as a reminder of payment and other issues.
NHJB-2336-F	First Appearance Highlights	This form is handed out to parties at First Appearance to summarize the information provided by the court.
NHJB-2385-F	Mediation Considerations	Distributed to parties at First Appearance, listing statutory reasons why they may not be appropriate for mediation.
NHJB-2386-F	Mediation Chart	Distributed to parties at First Appearance, showing case flow process.
NHJB-2412- F	Important Information for Attorneys	This form is used to provide important information to attorneys who represent parties to divorce, legal separation, or parenting actions in the Family Division.

Other

Form Number	Name of Form	Description	Associated Forms
NHJB-2036-DFS	Attorney's Statement	Statement submitted by court-appointed counsel, itemizing counsel and paralegal fees, as well as expenses.
NHJB-2089-DFS	Motion for Authorization to Obtain Services other than Counsel	Motion submitted by court-appointed counsel requesting authorization for additional services to prepare an adequate defense.
NHJB-2201-DFS	Motion for.....	Generic form completed by a person motioning the court for some relief.
NHJB-2202-DFPS	Agreement	Form is completed by parties who are filing an agreement with the court.
NHJB-2262-DFS	Statement for Services other than Counsel	Statement itemizing the duration and cost of services other than counsel provided to a party by a person or association, after such services have been approved for payment by the court.
NHJB-2277-FS	Petition for .......	To be used when party seeks relief for which there is no specialized court petition.
NHJB-2294-DFPS	Limited Appearance or Withdrawal by Attorney	To be filed by a limited representation attorney to: 1) appear for a client on a limited basis, 2) to withdraw his/her limited appearance, or 3) to move to withdraw his/her limited appearance.
NHJB-2340-F	Guardian ad Litem Statement	Statement submitted by Guardian ad Litem, itemizing fees and expenses.
NHJB-2341-F	Motion to Waive Filing Fee	Filed with a petition when party cannot afford the filing fee.
NHJB-2389-F	Mediator Statement	Statement submitted by mediator, itemizing fees and expenses.
NHJB-2391-DF	Appearance/Withdrawal	Form is used by a party or attorney who is filing an appearance or withdrawing their appearance.
NHJB-2409-F	Notification of Change of Address	Form for parties to use to keep court advised of address changes.
NHJB-2495-F	Objection .....
NHJB-2557-DFPS	Transcript Request Form	This form is completed when a request is made for a transcript	Instructions
NHJB-2589-F	Request for Hearing on Temporary Orders Pursuant to RSA 173-B:4	This form is used for the defendant to exercise their right pursuant to RSA 173-B:4 to request a sooner Final Hearing on the Temporary Domestic Violence Orders.
DSSP256 (2/98)	Division of State Police Criminal Record Release Authorization Form	Required in minor and adult guardianships and some adoption cases when completing background checks on the proposed guardians or adoptive parents	Instructions

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