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THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us
Court Name: Case Name: Case Number:
(if known)
MOTION TO BE EXEMPT FROM ATTENDING THE CHILD IMPACT PROGRAM
Pursuant to RSA 458-D:8 In the matter of I, Child Impact Program due to the following circumstances: a. I am currently incarcerated at b. I have previously attended this seminar on V of In the Matter of c. Other and , Case/Docket Number , hereby request to be exempted from the
, for the case of , or in the case filed in the Court of
Date
Signature
State of This instrument was acknowledged before me on My Commission Expires Affix Seal, if any
, County of by
Signature of Notarial Officer / Title Date
I certify that a copy of this form was mailed/delivered to opposing counsel/party on this ORDER Request for exemption is GRANTED. Request for exemption is DENIED. Time for completion of seminar is extended to ninety (90) days from the date of this order. So Recommended:
Date Signature of Marital Master Printed Name of Marital Master
So Ordered:
Date Signature of Judge Printed Name of Judge
NHJB-2343-F (12/27/2007) Page 1 of 1
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