Fill and Sign the Goshen Hugo Academic Hsaede Form

SU-WWW-004 (3/98) THE STATE OF NEW HAMPSHIRE SUPERIOR COURT County Case No. PERSONAL DATA SHEET 1. Name of person(s) completing this sheet Check if applicable: Because I believe that my safety, or the safety of my children is at risk, I request that the information contained in this Personal Data Sheet not be disclosed to the other party. The reasons are: 2. Type of case filed today: Divorce (Individual Petition) Modification Joint Petition for Divorce Enforcement Paternity/Legitimation Domestic Violence Custody/Support Other 3. Wife or child(ren)’s mother’s name Date of Birth Residence Address Mailing Address (if different) Phone Number (Home) (Work) Social Security Number Employer's Name Employee's Address 4. Husband or child(ren)’s father’s name Date of Birth Residence Address Mailing Address (if different) Phone Number (Home) (Work) Social Security Number Employer's Name Employer's Address 5. Child(ren)'s Full Name(s) D.O.B’s Social Security Number(s) 6. Have there been any child support, custody, divorce, adoption, juvenile, paternity, legitimati on or other court case concerning any child listed in your petition? yes no If Yes , identify each case by court, type of case, and date, and explain each: 7. Are there any other pending domestic violence, divorce, legal separation, separate maintenance, domestic relations, or other court case concerning you and your spouse or the other parent? yes no If Yes , identify each case by court, type of case, date and explain each: _________________________________ __________________________________________ Date Signature _________________________________ _________________________________________ Date Signature (If joint petition)