THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) MOTION TO WAIVE/REDUCE CHILD IMPACT SEMINAR FEE Pursuant to RSA 458-D:7 I, , hereby request that the court waive/reduce the child impact seminar fee or require my fee to be paid by my spouse. In support of this motion it is stated that: I am required to attend a child impact seminar pursuant to RSA 458-D and I cannot afford to pay the fee. (Check either box A or box B, whichever describes your situation) I currently receive public assistance. I asked the CIP provider to reduce or waive the fee. A copy of A. the document received from the provider denying my request is attached. OR I do not currently receive public assistance so the CIP provider will not waive or reduce the fee. B. My financial affidavit is attached. I am unable to pay the CIP fee for the following reasons: I request that the court waive or reduce the seminar fee, or in the alternative, require my spouse to pay. Date Signature I certify that on this date I provided a copy of this document to (other party) or to (other party's attorney) by: Hand-delivery OR US Mail OR E-mail (E-mail only by prior agreement of the parties based on Circuit Court Administrative Order). Signature Date ORDER Motion granted. CIP fee is waived. Motion granted. CIP fee is reduced to $ Motion granted. $ to Motion DENIED. It is further ordered that: Recommended: Date Signature of Marital Master Printed Name of Marital Master . (spouse) is ordered to pay the seminar fee in the amount or (name of CIP provider) on or before (date) 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-2345-F (03/25/2013) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com