Free Petition for Grandparent Visitation - Nebraska

Clear Form

THE STATE OF NEW HAMPSHIRE

JUDICIAL BRANCH

http://www.courts.state.nh.us

Court Name: Case Name: Case Number:
(if known)

PETITION FOR GRANDPARENT VISITATION

Pursuant to RSA 461-A:13
*If the parent of the minor child(ren) is unwed, any grandparent filing a petition under this section shall attach proof (for example, a copy of the birth certificate) of legitimation by the parent pursuant to RSA 460:29 or establishment of paternity. 1. Petitioner(s) Name(s) Date of Birth Residence Address
E-mail address


Mailing Address (if different)
Telephone Number (Home)
2. Name of Mother Date of Birth Residence Address
E-mail address
(Work)

Mailing Address (if different)
Telephone Number (Home)
3. Name of Father Date of Birth Residence Address
E-Mail address
(Work)

Mailing Address (if different)
Telephone Number (Home)
(Work)

4. If parents of children were married, list the date of marriage
5. Length of time child(ren) has been a resident of New Hampshire
6. List any minor children to be affected by this petition:
Date of Birth Name and address of person child is residing with
Name

NHJB-2228-FS (12/15/2006)

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Case Name: Case Number: PETITION FOR GRANDPARENT VISITATION

7. 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 listed above. 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 listed above. If you check this box, you must mail copies of this petition and the personal data sheet to DHHS at: New Hampshire Department of Health and Human Services Division of Child Support Services - Legal Unit 129 Pleasant Street Concord, NH 03301 8. Are there any pending adoption, juvenile, domestic violence, domestic relations, paternity, legitimation, custody, parental rights and 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 9. What orders do you want the court to make, and what reasons to you have, under RSA 461-A:13, for the court to make these orders?

Date

Petitioner(s) Signature Attorney for Petitioner(s) (if any)


Printed Name, Address, E-mail, and Phone Number of Attorney (if any) State of This instrument was acknowledged before me on My Commission Expires Affix Seal, if any
NHJB-2228-FS (12/15/2006)

, County of by Signature of Notarial Officer / Title
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