Free Instructions - New Hampshire

Instructions for completing Division of State Police Criminal Record Release Authorization (DSSP256)

Form use. This is not a probate court form. However, this form is required in minor and adult guardianships and some adoption cases when completing background checks on the proposed guardians or adoptive parents.

Section I · · · · · · Enter your complete Name on the first line in the following order: Your Last Name, Your Maiden Name or an Alias Name, if applicable, Your First Name and Your Middle Initial. Enter your complete Address including zip code on the second line. On the third line, enter your Date of birth, Hair color, Eye color and Sex. On the fourth line, enter your Driver's License number and the State in which you have a driver's license. Purpose for Record should have a mark in the `Other' check box and Court Case should be specified on the line provided next to it. (i.e. adult guardianship, adoption or minor guardianship) You will sign the form on the Your Signature line, and date it in the appropriate space to the right.

Section II In this section you are authorizing the release of your criminal record convictions, if any, to the court named. · On the first line, enter the Name of the county probate court or family division who will receive the record. · On the second line, enter the Address of the probate court or family division location including zip code.

Signature Section This form must be signed in the presence of a Notary Public or Justice of the Peace. They will complete the section immediately following your signature. You will sign the form on the Signature line, and date it in the appropriate space to the right. Bottom section of the form The Register of Probate or Family Division Clerk will complete this section.

Review the completed form for accuracy prior to filing it with the court. If completing this form on-line, some fields may be filled in automatically based on entries in other fields. If more space is needed for any question, please attach additional sheets of paper.

DSSP256 (03/2005) Instructions (06/2008)

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