Fill and Sign the This Decree is Choose One Form

NHJB-2071-F (03/28/2018) Page 1 of 7 THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH htt p://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) FINAL DECREE ON PETITION FOR DIVORCE, LEGAL SEPARATION, OR CIVIL UNION DISSOLUTION This decree is (choose one): Agreed to by Parties Proposed By Ordered by the Court after hearing on at which petitioner respondent appeared. 1. Type of Case: (Choose Divorce, Legal Separation or Civil Union Dissolution) DIVORCE: A decree of divorce is granted to the petitioner respondent parties based on: Irreconcilable differences that have caused the irremediable breakdown of the marriage; or Grounds stated in the petition. Cros s petition, if any, is dismissed. LEGAL SEPARATION: A decree of legal sepa ration is granted to petitioner respondent parties based on : Irreconcilable differences that have caused the irremediable breakdown of the marriage; or Grounds stated in the petition. Cros s petition, if any, is dismissed. CIVIL UNION DISSOLUTION: A decree of civi l union dissolution is granted to petitioner respondent parties based on : Irreconcilable differences that have caused the irremediable breakdown of the civil union; or Grounds stated in the petition. Cros s petition, if any, is dismissed. 2. Parenting Plan and Uniform Support Order N/A See attached Parenting Plan and Uniform Support Order 3. Dependents N/A The parties shall claim the mino r child(ren) and/or other qualifying relative as dependent(s) for all income tax purposes, in the following manner: Petitioner, if otherwise qual ified under federal/state law, shall be entitled to claim as tax dependent(s) for all years even years odd years other Respondent, if otherwise qualified under federal/state law, shall be entitled to claim as tax dependent(s) for all years even years odd years other A parent may only claim a child as a dependent if that parent is current on child support for the applicable tax year. Case Name: Case Number: FINAL DECREE ON PETITION FOR DIVORCE, LEGAL SEPARATION, OR CIVIL UNION DISSOLUTION NHJB-2071-F (03/28/2018) Page 2 of 7 4. OPTIONAL: Post-Secondary Educational Expenses N/A IMPORTANT NOTE: The court cannot order parties to pay for college or other educational expenses beyond the completion of high school unless BOTH parties agree. However, if the parties agree to contribute to these expenses by checking the boxes in Section 4, below, this agreement will become an enforceable order of the court. The parties agree to contributions to college or other educational expenses beyond the completion of high school in the following manner: Type of contribution (check all that apply): Contributions to an account by Petitioner Respondent Both (Specify the amount and frequency of contributions and account information. Also specify what will happen to the contributions in the event the child doe s not incur post-secondary educational expenses): Contribution of an asset: (Specify the account or other as set being contributed and its current balance or value. If an asset is identified specify how the asset will be used. Also specify what will happen to the contributions in the event the child does not incur post-s econdary educational expenses): Payments shall be made as post-secondary education expenses are incu rred. Payments shall be made by Petitioner Respondent Both (Specify amount to be paid by each party or the per centage or other formula agreed upon to determine the post-secondary education expense ob ligation agreed to by the parties): Select one of the following: Both parties agree that this post-secondary educational expense agreement IS modifiable based on a substantial change in circumstances that was not foreseeable when the agreement was signed. Both parties agree that this post-sec ondary education expense agreement is NOT modifiable and the specific dollar amount to be contributed by either or both parents is set forth above. Note: Before any court hearing to modify or en force the agreement described above, the parties shall participate in mediation. 5. Guardian ad Litem Fees N/A See Order on Appoint ment of Guardian ad Litem Other: 6. Alimony N/A shall pay the sum of $ per as alimony. This obligation shall terminate: See attached Uniform Support Order. Case Name: Case Number: FINAL DECREE ON PETITION FOR DIVORCE, LEGAL SEPARATION, OR CIVIL UNION DISSOLUTION NHJB-2071-F (03/28/2018) Page 3 of 7 7. Health Insurance for Spouse N/A The continuation of empl oyer-sponsored group medical health insurance benefits on be half of shall be governed by RSA 415:18. VII-b, COBRA, or other applicable law. The following additional provisions, if any, apply: shall maintain health insurance for the benefit of . This obligation shall terminate: shall maintain dental insurance for the benefit of . This obligation shall terminate: shall be responsible for payment of the premiums. This obligation shall terminate: Each party shall be responsible for his/her own medical and dental insuranc e and for paying all of his/her own unreimbursed medical, dental, optical, and other expenses not otherwise covered by insurance. 8. Life Insurance N/A Each party is awarded any and all life insurance policies owned by that party, free and clear of any right, title, or interest of the other. shall maintain a life insurance policy in the minimum amount of $ designatin g as trustee for the benefit of the child(ren). This obligation shall continue as long as the insured is obligated to pay support. Other: 9. Motor Vehicles N/A Each party is awarded the vehicles in his/her name or possession, free of any right, title or interest of the other. is awarded the free and clear of any interest of is awarded the free and clear of any interest of Each party shall be responsible for all expenses as to his/her vehicles, including car payments, maintenance, registra tion and insurance. Case Name: Case Number: FINAL DECREE ON PETITION FOR DIVORCE, LEGAL SEPARATION, OR CIVIL UNION DISSOLUTION NHJB-2071-F (03/28/2018) Page 4 of 7 10. Furniture and Other Personal Property N/A The parties have already fairly divided between themselves their household furniture, furnishings and all other tangible property (other than as specifically set forth below), and each party is awarded that property currently in his/her possession, free and clear of any interest of the other. Petitioner is awarded the following sp ecific items of personal property: Respondent is awarded the following specific items of personal property: 11. Retirement Plans and Other Tax-Deferred Assets N/A Each party is awarded any intere st in any pension, retirement, 401(k), IRA, or other retirement account that s/he may have and as shown on his/her respective financial affidavits free and clear of any interest of the other. is awarded one-half of ‘s IRA and/or 401(k) as of the date of this decree. is awarded one-half of ‘s pension plan which accrued betw een the date of the marriage or civil union and the date of the filing of the petition for divorce, legal separa tion, or dissolution pursuant to the Hodgins formula. Subject to th e above distribution, is awarded all other right, title, and interest in his/her pension plan, free of any further interest of A Qualified Domestic Relations Order (QDRO) shall be prepared by within a reasonable period of time from the date of this decree and filed with the Court for approval. Other: 12. Other Financial Assets N/A The parties are awarded their respective checking and/or savings bank accounts, credit union accounts, certificates of deposits and the like , and all similar accounts as shown on their individual financial affidavi ts filed with the court. Petitioner is awarded the follo wing bank accounts, stocks, b onds, mutual funds or other intangible pers onal property: Respondent is awarded the follo wing bank accounts, stocks, bond s, mutual funds or other intangible pers onal property: Case Name: Case Number: FINAL DECREE ON PETITION FOR DIVORCE, LEGAL SEPARATION, OR CIVIL UNION DISSOLUTION NHJB-2071-F (03/28/2018) Page 5 of 7 Other: 13. Business Interests of the Parties N/A is awarded all right, title, and interest in the business known as free of any claim or interest of the other party. shall be solely responsible for all debts of the business and shall be en titled to receive all profits from the business. shall transfer all property interest and stock to forthwith and shall resign as an officer or director in the business forthwith. Other: 14. Division of Debt N/A The parties shall each be responsible for any debt they have incurred after the date of separation, holding each othe r harmless of the same. The parties’ joint marital/civil unio n debt shall be divided as follows: Petitioner shall as sume and be solely respons ible for the following marital/civil union debts and obligations incurr ed during the marriage/civil union: Respondent shall assume and be solely responsible for the following marital/civil union debts and obligations incurred durin g the marriage/civil union: 15. Marital/Civil Union Home N/A is awarded all right, title and interest in the real estate located at: free of any right, title or interest of the other party. shall be responsible for the payment of the mortgage, insurance, and real estate taxes for this property and all expenses for this property. shall refinance the mortgage on the home so as to remo ve the other party’s name from the mortgage by or the home will be placed on the market and sold. The marital/civil union home shall be sold and, upon sale, the net proceeds shall be divided equally between the parties. Case Name: Case Number: FINAL DECREE ON PETITION FOR DIVORCE, LEGAL SEPARATION, OR CIVIL UNION DISSOLUTION NHJB-2071-F (03/28/2018) Page 6 of 7 Other: 16. Other Real Property N/A The real estate located at is awarded to , free of any right, title or interest of the other party. shall be responsible for the payment of the mortgage, insurance, and real estate taxes for this property and all expenses for this property. Other: 17. Enforceability after Death N/A The terms of this decree shall be a charge against each party’s estate. 18. Signing of Documents N/A Each party shall, within thirty (30) days, sign and deliver to the othe r party any document or paper that is needed to fulfill or accomplish the terms of this decree. 19. Restraining Order N/A is restrained and enjoined from entering the home or the place of employ ment of the other party, and from harassing, intimidating or threatening the other party or his/her re latives or other household members. Other: 20. Name Change (Divorce or Civil Union Dissolution Only) N/A may resume use of her/his former name: 21. Other Requests Attorney's Fees: Any party that unreasonably fails to co mply with this decree or other court orders (including "Unifo rm Support Order") may be responsibl e to reimburse the other party for whatever costs, includin g reasonable attorney’s fees, that ma y be incurred in order to enforce compliance. Tax Refunds: Any tax refund due or anticipated by the parties re sulting from their having filed a joint federal and/or state income tax return for this or any prior year shall, upon receipt, be endorsed by bo th parties and equally di stributed between them. Disclosure of Assets: The parties warrant that they have fully disclosed all assets within their knowledge on their resp ective Financial Affidavit, specifically including any pension, profit sharing or retirement account, along with reasonable estimated values of each asset. The financial information contained on each party's Financial Affidavit is accurate and complete and has been relied upon by the other party. Compliance With Rule 1.25-A (Family Division Only) : The parties have fully complied with Rule 1.25-A; or The parties agreed to limit their docu ment exchange under Rule 1.25-A. Case Name: Case Number: FINAL DECREE ON PETITION FOR DIVORCE, LEGAL SEPARATION, OR CIVIL UNION DISSOLUTION NHJB-2071-F (03/28/2018) Page 7 of 7 Mutual Releases: Other than as set forth in this decree or other order of this court (including "Uniform Support Order") each party releases and agrees to defend, indemnify and hold the other harmless from any and all claims of any nature whatsoever arising out of the marriage (including any cl aim for alimony). Obligations: Unless specifically mentioned in this decree, each part y shall be solely responsible for any bills, obligat ions or other indebtedness that he or she has charged or incurred before or during th e marriage or civil union. Change in Address or Employment: Each party shall promptly notify the other of any change in his/her address or te lephone number, and of any materi al change in employment as long as there are any continuing obligations un der this decree. “Material change” will include availability of medical, dental or life insurance and any substantial increase or decrease in earnings or other income. Waiver of Attendance: Both parties waive atte ndance at a final hearing. Miscellaneous: I/we believe that this is a fair and reasonable resolution of all the issues related to our marriage or civil union. I/we request that the Cour t approve this decree and incorporate all of its terms and conditions as part of the Decree of Di vorce, Decree of Legal Separation, or Decree of Civil Union Dissolution. Date Signature of Petitioner Date Signature of Attorney/Witness for Petitioner Date Signature of Respondent Date Signature of Attorney/Witness for Respondent I state that on this date I provided a copy of this document to (other party) or to (other party’s attorney) by: Hand-delivery OR US Mail OR E-mail (E-mail only by prior agreement of the parties based on Circuit Court Administrative Order) . Date Signature Recommended: Date Signature of Marital Master Printed Name of Marital Master So Ordered: I hereby certify that I have r ead the recommendation(s) and agree tha t, to the extent the marital master/judicial referee/hearing officer has made factual findings, she/he has applied the correct legal standard to the facts determined by the marital master/judicial referee/hearing officer. Date Signature of Judge Printed Name of Judge