Free Petition for Abuse or Neglect - New Hampshire

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THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us

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

In the interest of

, a minor

PETITION FOR ABUSE / NEGLECT
Pursuant to RSA 169-C
1. Petitioner Name Address 2. Minor Name Address 3. Legal Guardian of the child Address 4. Father name Address Mother name Address 5. The petitioner represents that the minor child was Name of person Address 6. Date(s) and time(s) of abuse/neglect Location of abuse/neglect 7. Details or facts of abuse/neglect (attach separate sheet if necessary) abused Date of Birth Telephone Date of Birth Telephone Date of Birth Telephone neglected by: Date of Birth Telephone

Date

Signature of Petitioner

State of This instrument was acknowledged before me on My commission expires: Affix seal, if any

, County of by
Signature of Notarial Officer / Title

.

ORDER AND NOTICE OF HEARING
The foregoing petition having been presented, it is ordered that a hearing be held on a.m./p.m. at the above-noted court and at the parents or legal guardian of the child, is/are hereby summoned to appear at the hearing.
Date C: Mother Father Law Enforcement DCYF Other:
Page 1 of 1

,

Clerk/Deputy Clerk

NHJB-2113-DF (12/06/2006) (formerly AOC 300-008/045)

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