Instructions
Clear Form
THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us
Court Name: Case Name: Case Number:
(if known)
NOTICE OF INTENT TO CLAIM PATERNITY
AND
REQUEST FOR HEARING
(RSA 170-B:5 and 170-B:6) 1. Alleged father of child Residence Address Mailing Address 2. Child's name Date of Birth 3. Mother of child named above Place of Birth
Telephone
I HEREBY CLAIM PATERNITY OF THE CHILD NAMED ABOVE AND REQUEST A HEARING TO PROVE THAT I AM THE FATHER OF THIS CHILD.
Date
Signature
State of
, County of by
Signature of Notarial Officer / Title
This instrument was acknowledged before me on My Commission Expires Affix Seal, if any
NHJB-2194-FP (10/01/2006) (formerly AOC-205-003 and AOC-205-008)
Page 1 of 1
Top of page