New Hampshire Certificate of Divorce Form

Clear Form
State of New Hampshire
CASE NUMBER
STATE FILE NUMBER
Certificate Of Divorce, Civil Union (CU) Dissolution
Legal Separation Or Annulment
This form must be word processed or typewritten. The following information will be completed by the petitioner as indicated or
by one of the joint petitioners and filed with the court prior to the hearing on the merits in accordance with court rules.
1.b. Suffix. 1c. Last name & suffix before 1st marriage or CU
Last (Current)
PERSON A 1a. Person A’s name – First Middle
(if applicable)
2. Person A’s gender
Male
Female
3a. Residence – City, town or location (at time of filing)
3b. County
4. Birthplace
5. Date of birth
6. Number of this marriage or CU
(State or Foreign Country)
(MM/DD/YYYY)
(Specify first, second, etc.)
8. If previously joined in marriage or civil union, how many ended by:
Divorce/Annulment
Number
PERSON B 10a. Person B’s name – First Middle
11. Person B’s gender
Male
Female
Elementary or secondary
Number
10c. Last name & suffix before 1st marriage or CU
(if applicable)
12a. Residence – City, town or location (at time of filing)
12b. County
13. Birthplace
14. Date of birth
15. Number of this marriage or CU
(State or Foreign Country)
(MM/DD/YYYY)
(Specify first, second, etc.)
17. If previously joined in marriage or civil union, how many ended by:
(do not include current marriage or civil union)
Death Number
Civil Union Dissolution
Divorce/Annulment
Number
MARRIAGE / 19. Place of this marriage or civil union
CIVIL UNION (City/Town )
21. Date couple last resided in same
household (MM/DD/YYYY)
self represented
Number
19b. County
12c. State
16. Social security number
18. Education: (specify highest grade completed)
Elementary or secondary
College (1-4 or 5+)
(0-12)
19c. State
20. Date of this marriage
(or foreign country)
or CU (MM/DD/YYYY)
22a. Number of children born alive or 22b. Number of children under age 18 in
adopted during this marriage/civil union this household as of date in Item 21
ATTORNEY 23a. Name of person completing form:
attorney
College (1-4 or 5+)
(0-12)
10.b. Suffix
Last (Current)
7. Social security number
9. Education: (specify highest grade completed)
(do not include current marriage or civil union)
Death Number
Civil Union Dissolution
3c. State
23b. Address
attorney
self represented
(Street and Number, City/Town, State, Zip Code)
23c. Date (this form was completed)
(MM/DD/YYYY)
BELOW THIS LINE TO BE COMPLETED BY THE COURT
24b. Cause for filing
24c. A decree was entered: There was an:
24a. Date petition
filed with court
Irreconcilable differences
Uncontested hearing
(MM/DD/YYYY)
Other (specify)
Contested hearing
Defaulted hearing
DECREE 25b. Date decree becomes final:
(MM/DD/YYYY)
27a. Name to be used by
Person A after divorce:
Same as present (1a & b)
Name prior to 1st
marriage or CU (1c)
Other (specify)
27b. Name to be used by
Person B after divorce:
Same as present (10a & b)
Name prior to 1st
marriage or CU (10c)
Other (specify)
26a. Name of hearing official: (first and last name)
28. Decision making
responsibility for
child/children shall be with:
Both Parents
Person A
Person B
Other (specify)
Not applicable
29a. Number of children under
age 18 for whom residential
responsibility is with:
Both Parents
#
Person A
#
Person B
#
Other (specify)
#
Not applicable
32a. Signature of court official: I certify that the above is correct to 32b. Court name:
the best of my knowledge.
25a. Type of decree
Divorce
Legal separation
Annulment
CU Dissolution
26b. Official capacity:
Judge
Marital Master
30. Residential
responsibility was:
Uncontested
Contested
Defaulted
Not applicable
31. Petitioner:
Person A
Person B
Joint
Other (specify)
32c. Date signed:
(MM/DD/YYYY)
SOS/DVRA VS 14A Rev 12/2010
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