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Of the Association of the Bar of the City of New York Form

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Type or print clearly. SU-WWW-008 (4/98) THE STATE OF NEW HAMPSHIRE SUPERIOR COURT _________________County Case No. _______________ In the matter of ___________________________________ PETITION FOR MODIFICATION 1. Your Name ___________________________________ Date of Birth __________________________ Residence Address ___________________________________________________________________ Town/CityCountyState 2.Other Party’s Name _________________________________Date of Birth_______________________Residence Address ___________________________________________________________________ Town/City CountyState 3.What type of case resulted in the present court order (divorce, paternity action, etc.)? And, what court issued the order?_________________________________________________________________________________________ _4. What present orders do you want the court to change? (Be specific and include date of order if possible.)_________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ _5. What do you want the new orders to say?_________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ _6. Why should the court change the present orders? (List each reason separately.)_________________________________________________________________________________________ __________________________________________________________________________________________ _ Type or print clearly. SU-WWW-008 (4/98)_________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________7.Please check one of the following regarding public assistance:[ ] No public assistance (AFDC/TANF) is now being or has within the last 6 months been provided, nor is medical assistance (Medicaid) presently being provided, for the minor children of the parties.[ ] The N.H. Department of Health and Human Services is providing or has provided within the last 6 months public assistance (AFDC/TANF) and/or medical assistance (Medicaid) for any minor child of the parties. If this is checked, you must mail copies of this petition and the personal data sheet to the Department at: OCS Legal Office6 Hazen Drive Concord, NH 03301 8.By filing this petition, you are asking that the court:A. Modify the present orders as listed above.B. Other (list): ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ C. Grant any other orders which may be appropriate.__________________________________________________________________________DateSignature (Sign in front of Notary Public or Justice of the Peace) __________________________________________Attorney (if any)___________________________________________Attorney’s Address State of New Hampshire_______________________ County The person signing this petition appeared and signed it before me and took oath that the statements in this petition are true, to the best of his or her knowledge and belief, and that he/she has mailed copies of the petition and personal data sheet to OCS (if required under paragraph 7). _______________________________________DateNotary Public/Justice of the Peace

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