CASE NUMBER
CERTIFICATE OF DIVORCE LEGAL SEPARATION OR ANNULMENT
State of New Hampshire
Clear Form
STATE FILE NUMBER
This form must be typewritten. The following information will be completed by the petitioner as indicated, and filed with the court prior to the hearing on the merits in accordance with court rules.
1. HUSBAND'S NAME FIRST MIDDLE LAST
2a. RESIDENCE CITY, TOWN, OR LOCATION (at time of filing)
2b. COUNTY
2c. STATE
HUSBAND
3. BIRTHPLACE (State or Foreign Country)
4. DATE OF BIRTH (Month, Day, Year)
5. NUMBER OF THIS MARRIAGE (specify first, second, etc.)
6. SOCIAL SECURITY NUMBER
7. IF PREVIOUSLY MARRIED HOW MANY ENDED BY: (Do Not Include Current Marriage) DEATH DIVORCE, ANNULMENT
8. EDUCATION (specify highest grade completed) ELEMENTARY OR SECONDARY (0-12) COLLEGE (1-4 or 5+)
9a. WIFE'S NAME FIRST
MIDDLE
LAST
9b. MAIDEN SURNAME
WIFE
10a. RESIDENCE CITY, TOWN, OR LOCATION (at time of filing)
10b. COUNTY
10c. STATE
11. BIRTHPLACE (State or Foreign Country)
12. DATE OF BIRTH (Month, Day, Year)
13. NUMBER OF THIS MARRIAGE (specify first, second, etc.)
14. SOCIAL SECURITY NUMBER
15. IF PREVIOUSLY MARRIED HOW MANY ENDED BY: (Do Not Include Current Marriage) DEATH DIVORCE, ANNULMENT
16. EDUCATION (specify highest grade completed) ELEMENTARY OR SECONDARY (0-12) COLLEGE (1-4 or 5+)
17a. PLACE OF THIS MARRIAGE CITY/TOWN
17b. COUNTY
17c. STATE (or Foreign Country)
18. DATE OF THIS MARRIAGE 18. (Month, Day, Year)
MARRIAGE
19. DATE COUPLE LAST RESIDED 19. IN SAME HOUSEHOLD
20a. NUMBER OF CHILDREN BORN ALIVE OR 20a. ADOPTED DURING THIS MARRIAGE
20b. NUMBER OF CHILDREN UNDER 18 IN 20b. THIS HOUSEHOLD AS OF DATE IN ITEM 19
20c. PETITIONER 20c. Husband 20c.
Wife
Other ________________________ 21c. DATE (this Form completed 21c. by attorney or Pro-Se)
21a. NAME OF PETITIONER'S ATTORNEY or PRO-SE (Type/Print)
21b. ADDRESS (Street and Number or Rural Route Number, City or Town, State, Zip Code)
ATTORNEY
BELOW THIS LINE TO BE COMPLETED BY COURT
22a. Date petition filed with court. (Month/Day/Year) 22. Cause for Filing: 22. 22. 23b. Date Decree Becomes Final: (Month/Day/Year) 22c. A decree was entered. There was an: 22c. 22c.
23a. Type of Decree: 23a. 23a.
Irreconcilable Differences Other (specify)
Uncontested Hearing Defaulted Hearing
Contested Hearing
Divorce Annulment
Legal Separation
24a. Name of Hearing Official: (Type or Print) (First, Last)
24b. Official Capacity: 24b.
Judge
Master
25. Name to be Used by Wife 25. After Divorce:
26. Decision Making Responsibility for Child/Children 26 Shall Be With: 25. 25. 25. 25. 25.
27a. Number of Children Under 18 for Whom Residential Responsibility Is With:
27. # 27a. # 27a. # 27a. # 27a. # 27a. # 27a. # 27a. # 27a.
27b.Residential Responsibility Was:
7b. 27b. Uncontested 27b. 27b. 27b.
DECREE
25. 25. 25. 25.
Same as Present (9a) Maiden (9b) Other (specify)
Both Parents Mother Father Other (specify) Not Applicable
Both Parents
(Number)
Mother
(Number)
Contested Defaulted Not Applicable
Father
(Number)
Other (specify)
(Number)
Not Applicable
28b. Court name 28c. Date Signed (Month, Day, Year)
28a. Signature of Court Official: I certify that the above is correct to the best of my knowledge.
V.S. 14a-88,'05