State Of New Hampshire Certificate Of Divorce, Civil Union (Cu) Dissolution Legal Separation Or Annulment

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State of New Hampshire
CASE NUMBER
STATE FILE NUMBER
Certificate Of Divorce, Civil Union (CU) Dissolution
Legal Separation Or Annulment
This form must be word processed or typewritten. The following information will be completed by the petitioner as indicated or
by one of the joint petitioners and filed with the court prior to the hearing on the merits in accordance with court rules.
st
1a. Person A’s name – First Middle
Last
1.b. Suffix. 1c. Last name & suffix before 1
marriage or CU
(Current)
PERSON A
(if applicable)
2. Person A’s gender
3a. Residence – City, town or location
3b. County
3c. State
(at time of filing)
Male
Female
4. Birthplace
5. Date of birth
6. Number of this marriage or CU
7. Social security number
(Specify first, second, etc.)
(State or Foreign Country)
(MM/DD/YYYY)
8. If previously joined in marriage or civil union, how many ended by:
9. Education:
(specify highest grade completed)
(do not include current marriage or civil union)
Elementary or secondary
College
(1-4 or 5+)
Death
Number
Divorce/Annulment
Number
(0-12)
Civil Union Dissolution
Number
st
10a. Person B’s name – First Middle
Last
10.b. Suffix 10c. Last name & suffix before 1
marriage or CU
(Current)
PERSON B
(if applicable)
11. Person B’s gender
12a. Residence – City, town or location
12b. County
12c. State
(at time of filing)
Male
Female
13. Birthplace
14. Date of birth
15. Number of this marriage or CU
16. Social security number
(State or Foreign Country)
(MM/DD/YYYY)
(Specify first, second, etc.)
17. If previously joined in marriage or civil union, how many ended by:
18. Education:
(specify highest grade completed)
(do not include current marriage or civil union)
Elementary or secondary
College
(1-4 or 5+)
Death
Number
Divorce/Annulment
Number
(0-12)
Civil Union Dissolution
Number
19. Place of this marriage or civil union
19b. County
19c. State
20. Date of this marriage
MARRIAGE /
(City/Town )
(or foreign country)
r CU
o
(MM/DD/YYYY)
CIVIL UNION
21. Date couple last resided in same
22a. Number of children born alive or
22b. Number of children under age 18 in
household
adopted during this marriage/civil union
this household as of date in Item 21
(MM/DD/YYYY)
23a. Name of person completing form:
23b. Address
attorney
self represented
23c. Date
(this form was completed)
ATTORNEY
attorney
self represented
(Street and Number, City/Town, State, Zip Code)
(MM/DD/YYYY)
BELOW THIS LINE TO BE COMPLETED BY THE COURT
24a. Date petition
24b. Cause for filing
24c. A decree was entered: There was an:
25a. Type of decree
filed with court
Irreconcilable differences
Uncontested hearing
Divorce
(MM/DD/YYYY)
Other (specify)
Contested hearing
Legal separation
Defaulted hearing
Annulment
CU Dissolution
25b. Date decree becomes final:
26a. Name of hearing official:
26b. Official capacity:
(first and last name)
DECREE
(MM/DD/YYYY)
Judge
Marital Master
27a. Name to be used by
28. Decision making
29a. Number of children under
30. Residential
Person A after divorce:
responsibility for
age 18 for whom residential
responsibility was:
Same as present (1a & b)
child/children shall be with:
responsibility is with:
Uncontested
st
Name prior to 1
Both Parents
Both Parents
#
Contested
marriage or CU (1c)
Person A
Person A
#
Defaulted
Other (specify)
Person B
Person B
#
Not applicable
Other (specify)
Other (specify)
#
Not applicable
Not applicable
27b. Name to be used by
31. Petitioner:
Person B after divorce:
Person A
Same as present (10a & b)
Person B
st
Name prior to 1
Joint
marriage or CU (10c)
Other (specify)
Other (specify)
32b. Court name:
32c. Date signed:
32a. Signature of court official
:
I certify that the above is correct to
(MM/DD/YYYY)
the best of my knowledge.
SOS/DVRA VS 14A Rev 12/2010
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