Free Petition for Guardianship of Minor - New Hampshire

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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)

Guardianship of

PETITION FOR GUARDIANSHIP OF MINOR
The petitioner states the following: 1. 2. Petition is made for guardianship over the minor's: Person and Estate Person Only Petitioner name Mailing address Petitioner name Mailing address 3. Attorney for petitioner Mailing address 4. The minor is: under Minor's legal name Mailing address Alternate names Alternate addresses 5. Name of minor's natural parents. If both parents are deceased, attach a list of the names and addresses of the minor's grandparents, adult siblings, aunts and uncles. (Attach copy of death certificate of deceased parent(s), if applicable.) Date of birth Father name Mailing address Residence address (if different from above) Mother name Mailing address Residence address (if different from above) 6. List the names and addresses of any persons having the principal care and custody of the minor during the 60 days preceding the filing of this petition. Name Relationship to minor Address Telephone Date of birth Telephone Telephone OR over the age of fourteen. (Attach copy of birth certificate.) Date of birth Telephone Estate Only

Relationship to minor Telephone Relationship to minor Telephone Telephone

NHJB-2162-P (10/01/2006) (formerly AOC-105-003)

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Case Name: Guardianship of Case Number: PETITION FOR GUARDIANSHIP OF MINOR

7.

Proposed guardian name Relationship to minor Mailing address Proposed guardian name Relationship to minor Mailing address

Date of birth Occupation Telephone Date of birth Occupation Telephone

8.

List names and addresses of any person(s) nominated as guardian(s) of the person and/or the estate of the minor in the will of a deceased parent. Relationship to minor Name Address Telephone

9.

Are there any pending adoption, juvenile, domestic violence, marriage dissolution, domestic relations, paternity, legitimation, custody or other proceedings affecting minor or parents of this Yes No If yes, attach a separate sheet identifying and explaining each. minor? Is an adoption of the minor by the proposed guardian(s) contemplated? Is the minor entitled to receive local, state or federal benefits and/or entitlements? Is there an existing child support order for this child? If yes, is support collected by the Division of Child Support Services? If no, are you seeking a child support order as part of this guardianship? Is there an existing court visitation order for this child? If yes, attach a copy of that order to this petition. Is there any reason that this child should not visit with his/her parents? If yes, state clearly and specifically any reason(s). Yes Yes Yes Yes Yes Yes Yes No No No No No No No

10. 11. 12.

13. 14.

15. 16.

Is this guardianship being sought by the Department of Health and Human Services as part of a permanency plan pursuant to the Adoption and Safe Families Act of 1997? Yes No Is the child an American Indian child as defined by the Indian Child Welfare Act? Yes No If yes, the name and address of the tribe are:

Is the tribe recognized by the federal government as eligible for federal services or certain Alaskan native corporations as defined in 43 U.S.C. §1602(c)? Yes 17.

No

Is this petition filed in conjunction with a settlement of minor's action, per RSA 464-A:42? Yes No If yes, attach a copy of the petition or proposed petition seeking approval and all supplemental documentation to be filed with the Superior or District Court.
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NHJB-2162-P (10/01/2006) (formerly AOC-105-003)

Case Name: Guardianship of Case Number: PETITION FOR GUARDIANSHIP OF MINOR

18.

If applying for guardianship over the minor's estate, provide the probable value and general character of the estate below: DESCRIPTION $ Real Estate Personal Property Income (include local, state and federal benefits) Debts $ $ $

19.

The petitioner requests that the following impartial appraiser be named to take an inventory and appraise the estate of the minor. (Appraiser is required only if minor has an estate.) Occupation Appraiser name Appraiser address

20.

State specific facts which are claimed to demonstrate that the appointment of a guardian is in the best interests of the minor. (Attach additional pages as needed. Make each allegation a separate paragraph and number each paragraph.)

REQUEST FOR TEMPORARY ORDERS and/or PERMANENT ORDERS The petitioner(s) request(s) that the following relief be granted in the best interests of the minor, after a hearing on the merits. (State clearly, and number separately, your requests to the court.)

21.

FOR EX PARTE RELIEF ONLY. State additional facts or attach an affidavit (statement under oath) alleging facts involving the circumstances of the minor which establish that unless the ex parte relief is granted, the minor will, or is likely to, suffer immediate or irreparable harm or injury.

REQUEST FOR EX PARTE ORDERS The petitioner(s) request(s) that the following ex parte (emergency) relief be granted. (State clearly, and number separately, your requests to the court.)

NHJB-2162-P (10/01/2006) (formerly AOC-105-003)

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Case Name: Guardianship of Case Number: PETITION FOR GUARDIANSHIP OF MINOR

Date Date

Petitioner Signature Petitioner 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

FOR COURT USE ONLY. The following consents, if required, will be obtained by the judge at the time of the hearing. We hereby voluntarily and knowingly give consent to the appointment of as guardian(s).

Date Date Date Date Date

Parent Signature Parent Signature Minor Signature Guardian Signature Guardian Signature

ORDER Upon consideration of this petition, it is decreed that the petition be granted and letters of guardianship be issued. Prior to the issuance of said letters, the guardian is ordered to file with the court, within days of this order, a fiduciary bond in the amount of $ , without sureties with personal sureties with corporate sureties.

Date

Judge

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NHJB-2162-P (10/01/2006) (formerly AOC-105-003)

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