Petition For Termination Of Parental Rights Rsa 170-C - New Hampshire
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3Instructions
Clear Form
THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
Court Name:
Case Name:
Termination of Parental Rights of
Case Number:
(if known)
PETITION FOR TERMINATION OF PARENTAL RIGHTS
RSA 170-C
NOTE: Pursuant to RSA 458-A, you must attach the Uniform Child Custody Jurisdiction and Enforcement Act
(UCCJEA) Affidavit (Form NHJB-2660-DFPS) to this petition.
Your petitioner(s) represents the following:
1.
Petitioner Name
Telephone
Petitioner Name
Telephone
Mailing Address
Residence Address
2.
Attorney Name
Telephone
Mailing Address
3.
Petitioner(s) relationship to child:
Guardian
Parent
Foster Parent
Legal Custodian
Authorized Agency
4.
Child Name
Male
Female
Date of Birth
Place of Birth
Residence Address
5.
Birth father name
Date of Birth
Mailing address
Birth mother name
Date of Birth
Mailing address
6.
If either parent is a minor, complete the following information as applicable.
Maternal father
Address
Maternal mother
Address
Paternal father
Address
Paternal mother
Address
NHJB-2188-F (01/01/2015)
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