Free Instructions - New Hampshire

Instructions for completing Surrender Of Parental Rights
(NHJB-2080-FP) (RSA 170-B:5 through 170-B:12) Form use. Any parent voluntarily surrendering their parental rights must complete this form. The form specifies the rights being surrendered. Top part of form ·COURT NAME: Enter the name of the county probate court where the document will be filed. (example: Belknap County Probate Court; Rockingham County Probate Court). ·CASE NAME: Enter the name of the birth name of the child to be adopted (example: Surrender of Parental Rights over Susan Ann Jones or John Adams). ·CASE NUMBER: Leave blank if not yet assigned by court OR fill in case number if it is known. Check off the box that indicates the parent that is surrendering their rights, either Birth Mother, Birth Father or Legal Father. Numbered part of form 1. Name of parent surrendering rights is the name of the person surrendering his or her parental rights and filing this document. Enter telephone number, city and state of residence and complete mailing address with zip code. Enter the surrendering parent's Date of Birth and Place of Birth, which is the city and state or country where he or she was born. Enter the Attorney for the surrendering parent on the line provided along with the telephone number, and complete mailing address with zip code. Enter the Name of the other parent of the child followed by that person's telephone number, city and state of residence and complete mailing address with zip code. Enter the other parent's Date of Birth and Place of Birth, which is the city and state or country where he or she was born. Child Name is the name of the child. Enter the full name of the child. Enter the child's Date of Birth and Place of Birth, which is the city and state or country where the child was born. Check off one box ­ either Yes or No ­ to indicate if this child is an Indian child as defined by the Indian Child Welfare Act? If yes, enter the name and address of tribe on the line provided. Check off one box ­ either Yes or No- to indicate if tribe is recognized as eligible for federal services or certain Alaskan native corporations. Check off one box ­ single, married, divorced or widowed ­ to indicate the birth mother's marital status. If married, divorced or widowed, enter name of spouse. If applicable, enter date of marriage and/or date of divorce on the lines provided. Check off one box ­ Yes or No ­ to indicate if you know the identity of the adoptive parents. Check off one box ­ Yes or No ­ to indicate if there are any pending court proceedings, as listed on the form, affecting the minor or the parents of the minor. If yes, attach a separate sheet explaining each court proceeding in detail.
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NHJB-2080-P Instructions (10/01/06)

Please Read Carefully the paragraphs that follow on the form, completing the information requested, if applicable, just prior to the signature line. Signature section Prior to signing this document, check off one box to indicate if you wish or do not wish to receive confirmation of the final adoption of this child. This form must be signed in the presence of the Judge. The judge 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 left.

Complete the next section ONLY if you are a minor or under guardianship. The parents or guardians of the surrendering birth parent must assent to this surrender if the surrendering parent is a minor or under guardianship. This form must be signed in the presence of a Judge, Justice of the Peace, or Notary Public. They will complete the section immediately following the parents or guardians signatures. The parents or guardians must enter their names on the blank line, sign the form, identify the relationship to the surrendering parent and enter their complete mailing address including zip code. Order This section will be completed by the judge once the document is filed with the court and reviewed in detail by the judge.

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.

NHJB-2080-P Instructions (10/01/06)

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