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Petition For Termination Of Parental Rights Form. This is a New Hampshire form and can be use in Probate Court Statewide.
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Tags: Petition For Termination Of Parental Rights, NHJB-2188-FP, New Hampshire Statewide, Probate Court
THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us
Court Name:
Case Name:
Termination of Parental Rights of
Case Number:
(if known)
PETITION FOR TERMINATION OF PARENTAL RIGHTS
RSA 170-C
NOTE: Pursuant to RSA 458-A, you must attach the Uniform Child Custody Jurisdiction and Enforcement Act
(UCCJEA) Affidavit (Form NHJB-2660-DFPS) to this petition.
Your petitioner(s) represents the following:
1.
Petitioner Name
Telephone
Petitioner Name
Telephone
Mailing Address
Residence Address
2.
Attorney Name
Telephone
Mailing Address
3.
Petitioner(s) relationship to child:
4.
Child Name
Date of Birth
Guardian
Legal Custodian
Parent
Foster Parent
Authorized Agency
Male
Female
Place of Birth
Residence Address
5.
Birth father name
Date of Birth
Mailing address
Birth mother name
Date of Birth
Mailing address
6.
If either parent is a minor, complete the following information as applicable.
Maternal father
Address
Maternal mother
Address
Paternal father
Address
Paternal mother
Address
NHJB-2188-FP (12/01/2010)
(formerly AOC-082E-003 and AOC-082E-008)
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Case Name: Termination of Parental Rights of
Case Number:
PETITION FOR TERMINATION OF PARENTAL RIGHTS
7.
The person having custody/guardianship/acting in loco parentis or the organization or
authorized agency having legal custody or providing care for the child is:
Name
Address
8.
The court has jurisdiction because the child is present in the State or is in the legal custody or
legal guardianship of an authorized agency located in the state, and the child, parent or
guardian resides in the county.
9.
Your petitioner respectfully represents that there are sufficient grounds for the termination of
the parental rights of
over
pursuant to RSA 170-C:5 due to: (Check those that are applicable.)
10.
Abandonment of the child
Failure to support, educate or care for the child
Failure to correct conditions of neglect or abuse under RSA 169-C
Mental deficiency or mental illness of the parent
Sexual, physical, emotional or mental abuse of the child
Parent is incarcerated for a felony and found, pursuant to RSA 169-C, to have abused
and neglected the child.
Parent has been convicted of one or more of the following offenses:
(a) Murder, pursuant to RSA 630:1-a or 630:1-b, of another child of the parent, a
sibling or step-sibling of the child, the child’s other parent, or other persons related
by blood or marriage, including a minor child who resided with the defendant.
(b) Manslaughter, pursuant to RSA 630:2, of another child of the parent, a sibling or
step-sibling of the child, the child’s other parent, or other persons related by blood or
marriage, including a minor child who resided with the defendant.
(c) Attempt, pursuant to RSA 629:1, solicitation, pursuant to RSA 629:2, or
conspiracy, pursuant to RSA 629:3, to commit any of the offenses specified in
subparagraphs (a) or (b) above.
(d) A felony assault under RSA 631:1, 631:2, 632-A:2, or 632-A:3 which resulted in
injury to the child, a sibling or step-sibling of the child, the child’s other parent, or
other persons related by blood or marriage, including a minor child who resided with
the defendant.
Specify here your factual allegations in support of your petition.
NHJB-2188-FP (12/01/2010)
(formerly AOC-082E-003 and AOC-082E-008)
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Case Name: Termination of Parental Rights of
Case Number:
PETITION FOR TERMINATION OF PARENTAL RIGHTS
11.
If petitioners are foster parents, the following conditions have been met:
(a) The child has lived in the foster home continuously for 24 months; and
(b) The foster parents have requested in writing the licensed child-placing agency to legally
free the child for adoption, but the agency has not initiated proceedings, and there is
reasonable cause to believe the grounds exist.
12.
Your petitioner asks that the parental rights of
over
be terminated and that custody or guardianship of
be transferred to
of
I swear or affirm that the foregoing information is true and correct to the best of my knowledge.
Date
Petitioner Signature
Date
Petitioner Signature
State of
, County of
This instrument was acknowledged before me on
My Commission Expires
Affix Seal, if any
by
Signature of Notarial Officer / Title
To be completed by Division for Children, Youth and Families ONLY.
Court Name
Case Number
Attorney representing parents
Telephone
Address
Telephone
DCYF Attorney
Address
DCYF Social Worker
Telephone
Address
Child's GAL
Telephone
Address
NHJB-2188-FP (12/01/2010)
(formerly AOC-082E-003 and AOC-082E-008)
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