THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) PARENTING PETITION This form replaces the former “Petition for Custody” 1. Petitioner Name Relationship to Child E-mail Address Date of Birth Residence Address Mailing Address (if different) Telephone Number (Home) 2. (Work) Respondent Name Date of Birth Relationship to Child E-mail Address Residence Address Mailing Address (if different) Telephone Number (Home) 3. (Work) Length of time petitioner has been a resident of New Hampshire Length of time child(ren) has resided in New Hampshire 4. List minor children born to or adopted by the parties: Name 5. Date of Birth Name Date of Birth Please check one of the following regarding public assistance. No public assistance (TANF) is now being or has within the last 6 months been provided, nor is medical assistance (Medicaid) presently being provided, for any minor child of the parties. The N. H. Department of Health and Human Services is providing or has provided within the last 6 months public assistance (TANF) and/or medical assistance (Medicaid) for a minor child or children of the parties. If you check this box, you must mail copies of this petition and the Personal Data Sheet (NHJB-2077-FS) to DHHS at: New Hampshire Department of Health and Human Services Division of Child Support Services - Legal Unit 129 Pleasant Street Concord, NH 03301 NHJB-2061-FS (05/01/2006) Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Case Name: Case Number: PARENTING PETITION 6. Are there any past or pending adoption, juvenile, domestic violence, domestic relations, paternity, legitimation, custody, parental rights or responsibilities, or other proceedings in any court in any state affecting any child(ren) named in this petition or parents of those children? Yes No If yes, specify 7. Requests for court orders: A. TEMPORARY. The Petitioner respectfully requests that the Court issue temporary orders on any of the following issues. (Check all that apply). A temporary order is in effect until the final hearing. Child support Parenting Plan Other B. FINAL. The Petitioner respectfully requests that the Court issue a final order approving or establishing the following (Check all that apply): A parenting plan which describes the parties’ parental rights and responsibilities relating to minor children; Child support obligations for any minor children; Any other relief which may be appropriate; Other: Attorney for Petitioner (if any) Petitioner Signature Date Printed Name, Address, E-mail, and Phone Number of Attorney , State of Subscribed and sworn to before me, at County on Date My Commission Expires Signature of Notarial Officer NHJB-2061-FS (05/01/2006) Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com