THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) FINAL DECREE ON PETITION FOR DIVORCE, LEGAL SEPARATION, OR CIVIL UNION DISSOLUTION This decree is (choose one): Agreed to by Parties Proposed By Ordered by the Court after hearing on 1. at which petitioner respondent appeared. Type of Case: (Choose Divorce, Legal Separation or Civil Union Dissolution) DIVORCE: A decree of divorce is granted to the petitioner respondent parties based on: Irreconcilable differences that have caused the irremediable breakdown of the marriage; or Grounds stated in the petition. Cross petition, if any, is dismissed. LEGAL SEPARATION: A decree of legal separation is granted to petitioner respondent parties based on: Irreconcilable differences that have caused the irremediable breakdown of the marriage; or Grounds stated in the petition. Cross petition, if any, is dismissed. CIVIL UNION DISSOLUTION: A decree of civil union dissolution is granted to on: petitioner respondent parties based Irreconcilable differences that have caused the irremediable breakdown of the civil union; or Grounds stated in the petition. Cross petition, if any, is dismissed. 2. Parenting Plan and Uniform Support Order N/A See attached Parenting Plan and Uniform Support Order 3. 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: Petitioner shall be entitled to claim all even odd years. dependent(s) in as tax Respondent shall be entitled to claim all even odd years. dependent(s) in as tax A parent may only claim a child as a dependent if that parent is current on child support for the applicable tax year. NHJB-2071-FS (01/01/2011) Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case Name: Case Number: FINAL DECREE ON PETITION FOR DIVORCE, LEGAL SEPARATION, OR CIVIL UNION DISSOLUTION 4. Guardian ad Litem Fees See Order on Appointment of Guardian ad Litem N/A Other: N/A shall pay the sum of $ per as alimony. This obligation shall terminate: . See attached Uniform Support Order. 5. Alimony 6. N/A Health Insurance for Spouse The continuation of ’s employer-sponsored group health medical/dental health insurance benefits on behalf of shall be governed by RSA 415:18, VII. The following additional provisions, if any, apply: shall maintain health insurance for the benefit of . This obligation shall terminate: . shall be responsible for payment of the premiums. This obligation shall terminate: . Each party shall be responsible for his/her own medical and dental insurance and for paying all of his/her own unreimbursed medical, dental, optical, and other expenses not otherwise covered by insurance. 7. Life Insurance N/A Each party is awarded any and all life insurance policies owned by that party, free and clear of any right, title, or interest of the other. 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. Other: 8. Motor Vehicles N/A Each party is awarded the vehicles in his/her name or possession, free of any right, title or interest of the other. is awarded the free and clear of any interest of NHJB-2071-FS (01/01/2011) Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case Name: Case Number: FINAL DECREE ON PETITION FOR DIVORCE, LEGAL SEPARATION, OR CIVIL UNION DISSOLUTION is awarded the free and clear of any interest of 9. Each party shall be responsible for all expenses as to his/her vehicles, including car payments, maintenance, registration and insurance. Furniture and Other Personal Property N/A The parties have already fairly divided between themselves their household furniture, furnishings and all other tangible property (other than as specifically set forth below), and each party is awarded that property currently in his/her possession, free and clear of any interest of the other. Petitioner is awarded the following specific items of personal property: Respondent is awarded the following specific items of personal property: 10. Retirement Plans and Other Tax-Deferred Assets N/A Each party is awarded any interest in any pension, retirement, 401(k), IRA, or other retirement account that s/he may have and as shown on his/her respective financial affidavits free and clear of any interest of the other. is awarded one-half of ‘s IRA and/or 401(k) as of the date of this decree. is awarded one-half of ‘s pension plan which accrued between the date of the marriage or civil union and the date of the filing of the petition for divorce, legal separation, or dissolution pursuant to the Hodgins formula. Subject to the above distribution, is awarded all other right, title, and interest in his/her pension plan, free of any further interest of A Qualified Domestic Relations Order (QDRO) shall be prepared by within a reasonable period of time from the date of this decree and filed with the Court for approval. Other: 11. Other Financial Assets N/A The parties are awarded their respective checking and/or savings bank accounts, credit union accounts, certificates of deposits and the like, and all similar accounts as shown on their individual financial affidavits filed with the court. Petitioner is awarded the following bank accounts, stocks, bonds, mutual funds or other intangible personal property: NHJB-2071-FS (01/01/2011) Page 3 of 6 American LegalNet, Inc. www.FormsWorkFlow.com . Case Name: Case Number: FINAL DECREE ON PETITION FOR DIVORCE, LEGAL SEPARATION, OR CIVIL UNION DISSOLUTION Respondent is awarded the following bank accounts, stocks, bonds, mutual funds or other intangible personal property: Other: 12. Business Interests of the Parties as N/A is awarded all right, title, and interest in the business known free of any claim or interest of the other party. shall be solely responsible for all debts of the business and shall be entitled to receive all profits from the business. shall forthwith and transfer all property interest and stock to shall resign as an officer or director in the business forthwith. Other: 13. N/A Division of Debt The parties shall each be responsible for any debt they have incurred after the date of separation, holding each other harmless of the same. The parties’ joint marital/civil union debt shall be divided as follows: Petitioner shall assume and be solely responsible for the following marital/civil union debts and obligations incurred during the marriage/civil union: Respondent shall assume and be solely responsible for the following marital/civil union debts and obligations incurred during the marriage/civil union: 14. Marital/Civil Union Home N/A is awarded all right, title and interest in the real estate located at: free of any right, title or shall be responsible for the interest of the other party. payment of the mortgage, insurance, and real estate taxes for this property and all expenses for this property. shall refinance the mortgage on the home so as to remove the other party’s name from the mortgage by or the home will be placed on the market and sold. NHJB-2071-FS (01/01/2011) Page 4 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case Name: Case Number: FINAL DECREE ON PETITION FOR DIVORCE, LEGAL SEPARATION, OR CIVIL UNION DISSOLUTION The marital/civil union home shall be sold and, upon sale, the net proceeds shall be divided equally between the parties. Other: 15. Other Real Property N/A The real estate located at is awarded to the , free of any right, title or interest of the other party, but subject to any encumbrance thereon. Other: 16. N/A Enforceability after Death The terms of this decree shall be a charge against each party’s estate. 17. Signing of Documents N/A Each party shall, within thirty (30) days, sign and deliver to the other party any document or paper that is needed to fulfill or accomplish the terms of this decree. 18. 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: 19. Name Change (Divorce or Civil Union Dissolution Only) N/A may resume use of her/his former name: 20. 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. Tax Refunds: Any tax refund due or anticipated by the parties resulting from their having filed a joint federal and/or state income tax return for this or any prior year shall, upon receipt, be endorsed by both parties and equally distributed between them. Disclosure of Assets: The parties warrant that they have fully disclosed all assets within their knowledge on their respective Financial Affidavit, specifically including any pension, profit sharing or retirement account, along with reasonable estimated values of each asset. The financial information contained on each party's Financial Affidavit has been relied upon by the other party. Mutual Releases: Other than as set forth in this decree or other order of this court (including "Uniform Support Order") each party releases and agrees to defend, indemnify and hold the other harmless from any and all claims of any nature whatsoever arising out of the marriage (including any claim for alimony). NHJB-2071-FS (01/01/2011) Page 5 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case Name: Case Number: FINAL DECREE ON PETITION FOR DIVORCE, LEGAL SEPARATION, OR CIVIL UNION DISSOLUTION Obligations: Unless specifically mentioned in this decree, each party shall be solely responsible for any bills, obligations or other indebtedness that he or she has charged or incurred before or during the marriage or civil union. 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. Waiver of Attendance: Both parties waive attendance at a final hearing. Miscellaneous: I/we believe that this is a fair and reasonable resolution of all the issues related to our marriage or civil union. I/we request that the Court approve this decree and incorporate all of its terms and conditions as part of the Decree of Divorce, Decree of Legal Separation, or Decree of Civil Union Dissolution. 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 mailed/delivered a copy of this document to to Date (the other party) or (the other party’s attorney). 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-2071-FS (01/01/2011) Page 6 of 6 American LegalNet, Inc. www.FormsWorkFlow.com