Petition For Termination Of Parental Rights Rsa 170-C - New Hampshire Page 2
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3Case Name: Termination of Parental Rights of
Case Number:
PETITION FOR TERMINATION OF PARENTAL RIGHTS
7.
The person having custody/guardianship/acting in loco parentis or the organization or
authorized agency having legal custody or providing care for the child is:
Name
Address
8.
The court has jurisdiction because the child is present in the State or is in the legal custody or
legal guardianship of an authorized agency located in the state, and the child, parent or
guardian resides in the county.
9.
Your petitioner respectfully represents that there are sufficient grounds for the termination of
the parental rights of
over
pursuant to RSA 170-C:5 due to: (Check those that are applicable.)
Abandonment of the child
Failure to support, educate or care for the child
Failure to correct conditions of neglect or abuse under RSA 169-C
Mental deficiency or mental illness of the parent
Sexual, physical, emotional or mental abuse of the child
Parent is incarcerated for a felony and found, pursuant to RSA 169-C, to have abused
and neglected the child.
Parent has been convicted of one or more of the following offenses:
(a) Murder, pursuant to RSA 630:1-a or 630:1-b, of another child of the parent, a
sibling or step-sibling of the child, the child’s other parent, or other persons related
by blood or marriage, including a minor child who resided with the defendant.
(b) Manslaughter, pursuant to RSA 630:2, of another child of the parent, a sibling or
step-sibling of the child, the child’s other parent, or other persons related by blood or
marriage, including a minor child who resided with the defendant.
(c) Attempt, pursuant to RSA 629:1, solicitation, pursuant to RSA 629:2, or
conspiracy, pursuant to RSA 629:3, to commit any of the offenses specified in
subparagraphs (a) or (b) above.
(d) A felony assault under RSA 631:1, 631:2, 632-A:2, or 632-A:3 which resulted in
injury to the child, a sibling or step-sibling of the child, the child’s other parent, or
other persons related by blood or marriage, including a minor child who resided with
the defendant.
(e) Has been convicted of or who has pled guilty or nolo contendere to a violation of
sexual assault as defined in RSA 632-A:2 through RSA 632-A:4, or a similar statute
in another state against the birth mother for his conduct in fathering the child;
10.
Specify here your factual allegations in support of your petition.
NHJB-2188-F (01/01/2015)
Page 2 of 3
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