THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) DECREE ON PARENTING PETITION This decree is (choose one): Agreed to by Parties Proposed By Ordered by the Court after hearing on at which petitioner respondent appeared. This decree is (choose one): TEMPORARY. The completed paragraphs apply while this case is pending with this Court. FINAL. The completed paragraphs will be incorporated in the Court’s final order. 1. N/A Parenting Plan and Uniform Support Order See attached Parenting Plan and Uniform Support Order 2. Tax Exemptions for Children N/A The parties shall claim the minor child(ren) as dependent(s) for all income tax purposes, in the following manner: shall be entitled to claim as his/her tax dependent in all even odd years. as his/her tax dependent in shall be entitled to claim all even odd years. A parent may only claim a child as a dependent if that parent is current on child support for the applicable tax year. 3. Guardian ad Litem Fees See Order on Appointment of Guardian ad Litem N/A Other: 4. N/A shall maintain a life insurance policy in the minimum amount of $ designating as trustee for the benefit of the child(ren). This obligation shall continue as long as the insured is obligated to pay support. Life Insurance Other: 5. Enforceability After Death N/A The terms of this decree shall be a charge against each party’s estate. NHJB-2078-FS (01/01/2011) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case Name: Case Number: DECREE ON PARENTING PETITION 6. Restraining Order N/A is restrained and enjoined from entering the home or the place of employment of the other party, and from harassing, intimidating or threatening the other party or his/her relatives or other household members. Other: 7. Other Requests Attorney's Fees: Any party that unreasonably fails to comply with this decree or other court orders (including "Uniform Support Order") may be responsible to reimburse the other party for whatever costs, including reasonable attorney’s fees, that may be incurred in order to enforce compliance. Change in address or employment: Each party shall promptly notify the other of any change in his/her address or telephone number, and of any material change in employment as long as there are any continuing obligations under this decree. “Material change” will include availability of medical, dental or life insurance and any substantial increase or decrease in earnings or other income. Miscellaneous: I/we request that the Court approve this decree. Witness/Attorney for Petitioner Petitioner Signature Date Witness/Attorney for Respondent Respondent Signature Date This decree is proposed by . I certify that on this date I (the other party) or mailed/delivered a copy of this document to (the other party’s attorney). to Date Signature Recommended: Date Signature of Marital Master Printed Name of Marital Master So Ordered: I hereby certify that I have read the recommendation(s) and agree that, to the extent the marital master/judicial referee/hearing officer has made factual findings, she/he has applied the correct legal standard to the facts determined by the marital master/judicial referee/hearing officer. Date Signature of Judge Printed Name of Judge NHJB-2078-FS (01/01/2011) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com