Certificate Of Divorce - New Hampshire

SOS/DVRA VS 14A Rev 12/2010
State of New Hampshire
CASE NUMBER
Certificate Of Divorce, Civil Union (CU) Dissolution
STATE FILE NUMBER
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 accord ance with court rules.
1a. Person A’s name – First
Middle Last
(Current)
1.b. Suffix. 1c. Last name & suffix before 1
st
marriage or CU
(if applicable)
2. Person A’s gender
Male Female
3a. Residence – Cit y, town or location
(at time of filing) 3b. County 3c. State
4. Birthplace
(State or Foreign Country)
5. Date of birth
(MM/DD/YYYY)
6. Number of this marriage or CU
(Specify first, second, etc.)
7. Social security number
9. Education: (specify highest grade completed) 8. If previousl y joined in marriage or civil union, how many ended b y:
(do not include current marriage or civil union)
Death Number Divorce/Annulment Number
Civil Union D issolution Number
Elementary or secondary
(0-12)
College (1-4 or 5+)
10a. Person B’s name – F irst
Middle Last
(Current)
10.b. Suffix 10c. Last name & suffix before 1
st
marriage or CU
(if applicable)
11. Person B’s gender
Male Female
12a. Residence – Cit y, to wn or location
(at time of filing) 12b. County 12c. State
13. Birthplace
(State or Foreign Country)
14. Date of bir t h
(MM/DD/YYYY)
15. Number of this marriage or CU
(Specify first, second, etc.)
16. Social sec urity number
18. Education: (specify highest grade completed) 17. If previously joined in marriage or civil union, how many ended by:
(do not include current marriage or civil union)
Death Number Divorce/Annulment Number
Civil Union D issolution Number
Elementary or secondary
(0-12)
College (1-4 or 5+)
19. Place of this marriage or civil union
(City/Town )
19b. County 19c. State
(or foreign count ry)
20. Date of this marriage
or CU (MM/DD/YYYY)
21. Date couple last resided in same
household (MM/DD/YYYY)
22a. Number of children born alive or
adopted during this marriage/civil uni on
22b. Number of children und er age 18 in
this household as of date in Item 21
23a. Name of person completing form:
attorney self represented
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
24a. Date petition
filed with court
(MM/DD/YYYY)
24b. Cause for filing
Irreconcilable differences
Other (specify)
24c. A decree was entered: There was an:
Uncontested heari ng
Contested hearing
Defaulted hearing
25a. T ype of decree
Divorce
Legal separati on
Annulment
CU Dissolution
25b. Date decree becomes final:
(MM/DD/YYYY)
26a. Name of hearing official: (first and last name) 26b. Official capacity:
Judge Marital Master
27a. Name to be used by
Person A after divorce:
Same as present (1a & b)
Name prior to 1
st
marriage or CU (1c)
Other (specify)
30. Residential
responsibility was:
Uncontested
Contested
Defaulted
Not applicable
27b. Name to be used by
Person B after divorce:
Same as present (10a & b)
Name prior to 1
st
marriage or CU (10c)
Other (specify)
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 resid ential
responsibilit y is with:
Both Parents #
Person A #
Person B #
Other (specify) #
Not applicable
31. Petitioner:
Person A
Person B
Joint
Other (specify)
32a. Signature of court official: I certify that the above is correct to
the best of my knowledge.
32b. Court na me: 32c. Date signed:
(MM/DD/YYYY)
PERSON
A
ATTORNEY
DECREE
MARRIAGE /
CIVIL UNION
PERSON B
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