Free Petition to Expunge - New Hampshire


File Size: 74.2 kB
Pages: 2
Date: December 30, 2008
File Format: PDF
State: New Hampshire
Category: Court Forms - State
Author: NHJB
Word Count: 519 Words, 3,119 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.courts.state.nh.us/forms/nhjb-2135-df.pdf

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THE STATE OF NEW HAMPSHIRE

JUDICIAL BRANCH

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

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

PETITION TO EXPUNGE (REMOVE)

Pursuant to RSA 169-C:35
1. Petitioner Name Date of Birth Residence Address
Social Security Number


Mailing Address (if different)
Telephone Number (Home)
2. Child's Name 3. Date of Court Finding (if applicable) 4. The petitioner states as follows: a. Pursuant to RSA 169-C:35, my name was listed as reported by the New Hampshire Department of Health and Human Services, Division for Children, Youth and Families ("the Department") as of (date) on the State's Central Registry of founded reports of abuse and neglect. It has been: More than one (1) year since the date my name was entered on the State's Central Registry; OR Three (3) or more years since the denial of my last Petition to have my name expunged (removed) from the State's Central Registry. b. Consistent with RSA 169-C:35, IV(c), I understand that as a result of this Petition to Expunge, the Court will order the Department to: (1) Submit my name, address, date of birth and social security number to the New Hampshire Department of Safety to conduct a search of their criminal records and for the results of this search to be submitted to the Court; (2) Report to the Court concerning any additional founded abuse and/or neglect reports against me; and (3) Provide any additional information that may aid the Court in making a determination on this Petition to Expunge. c. Attached is a signed and notarized Criminal Records Release. d. In addition to the above, I ask the Court to consider the following information in support of the Petition to Expunge: (Work) Date of Birth

NHJB-2135-DF (12/06/2006)

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Case Name: Case Number: PETITION TO EXPUNGE

e. Upon the Court's receipt and review of the information provided by the Department, I request that the Court grant this Petition to Expunge and order the Department to remove my name from the State's Central Registry, OR, in the alternative, that the Court schedule a hearing on this Petition.

Date

Signature of Petitioner

Printed Name 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

THE COURT MAKES THE FOLLOWING ORDERS: DCYF shall submit the petitioner's name, address, date of birth and social security number to the New Hampshire Department of Safety to conduct a search of their criminal records and for the results of this search to be submitted to the Court; DCYF shall report to the Court concerning any additional founded abuse and/or neglect reports against the petitioner; and DCYF shall provide any additional information that may aid the Court in making a
determination on this Petition to Expunge.
Other:

Recommended:
Date Printed Name of Marital Master Signature of Marital Master

So Ordered:
Date Printed Name of Judge Signature of Judge

C:

Petitioner

Court

NH DCYF, Central Registry

Other:

NHJB-2135-DF (12/06/2006)

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