Petition For Divorce Page 3
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4Case Name:
Case Number:
PETITION FOR DIVORCE
10. Optional:
I am alleging, under oath, that my or my child/ren’s health, safety, or liberty would be
jeopardized by the disclosure of identifying information set forth in this Petition. To support my allegation, I
state as follows:
11. Please check one of the following regarding public assistance.
No public assistance (TANF) is now being or has within the last 6 months been provided, nor is
medical assistance (Medicaid) presently being provided, for any minor child of the parties.
The N. H. Department of Health and Human Services is providing or has provided within the last 6
months public assistance (TANF) and/or medical assistance (Medicaid) for a minor child or children of
the parties. If you check this box, you must mail copies of this petition and the Personal Data Sheet
(NHJB-2077-FS) to DHHS at:
New Hampshire Department of Health and Human Services
Division of Child Support Services - Legal Unit
129 Pleasant Street
Concord, NH 03301
12. To the knowledge of the parties, is either party pregnant?
Yes
No
13. Do the parties own real estate jointly?
Yes
No
Does the petitioner own real estate individually?
Yes
No
Does the respondent own real estate individually?
Yes
No
14. The cause for divorce is: (Check one or both)
Irreconcilable differences have developed that have caused the irremediable breakdown of the
marriage.
Other:
15. Requests for court orders:
A.
TEMPORARY. The Petitioner respectfully requests that the Court issue temporary orders on any of
the following issues. (Check all that apply). A temporary order is in effect until the divorce is granted.
Child support
Parenting Plan
Use of personal property and payment of debt
Alimony
Use of family home
Other:
B.
FINAL. The Petitioner respectfully requests that the Court grant a divorce, equitably divide personal
property, real estate, debts and obligations of the parties, and issue a final order approving or
establishing the following (check all that apply):
A parenting plan which describes the parties’ parental rights and responsibilities relating to minor
children;
Child support obligations for any minor children;
Alimony;
Any other relief which may be appropriate;
Other:
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NHJB-2057-FS (12/01/2010)
Page 3 of 4
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