Fill and Sign the Working with the Courts in Child Protection Child Welfare Form

NHJB-2078-F (11/25/2013) Page 1 of 3 THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) DECREE ON PARENTING PETITION This decree is (choose one): Agreed to by Parties Proposed By Ordered by the Court afte r hearing on at which petitioner respondent appeared. This decree is (choose one): TEMPORARY. The completed paragraphs apply wh ile this case is pending with this Court. FINAL. The completed paragraphs will be inco rporated in the Court’s final order. 1. Parenting Plan and Uniform Support Order N/A See attached Parenting Plan and Uniform Support Order 2. Tax Exemptions for Children N/A The parties shall claim the minor child(ren) as dependent(s) for all income tax purposes, in the following manner: shall be entitled to claim as his/her tax dependent in all even odd years. shall be entitled to claim as his/her tax dependent in all even odd years. A parent may only claim a child as a dependent if that parent is current on child support for the applicable tax year. 3. Guardian ad Litem Fees N/A See Order on Appoint ment of Guardian ad Litem O th er: 4. Life Insurance N/A shall maintain a life insurance policy in the minimum amount of $ designating as trustee for the benefit of the child(ren). This obligation shall continue as long as the insured is obligated to pay support. Other: 5. Enforceability After Death N/A The terms of this decree shall be a charge against each party’s estate. 6. Restraining Order N/A is restrained and enjoine d from entering the home or the place of employment of the other party, and from harassing, intimidating or threatening the other party or his/her relatives or other household members. O th er: Case Name: Case Number: DECREE ON PARENTING PETITION NHJB-2078-F (11/25/2013) Page 2 of 3 7. 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. Change in address or employment: Each party shall promptly notify the other of any change in his/her address or telephone number, and of any material change in employment as long as there are any continui ng obligations under this decree. “Mat erial change” will include availability of medical, dental or life in surance and any substantial increas e or decrease in earnings or other income. Compliance with Rule 1.25-A: The parties complied fully with Rule 1.25-A; or The parties agreed to limit their document ex change under Rule 1.25-A. Miscellaneous: 8. 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 does not incur post-secondary educational expenses): Contribution of an asset: (Specify the account or other asset being cont ributed 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-secondary educational expenses): Payments shall be made as post-secondary education expenses are incurred. Payments shall be made by Petitioner Respondent Both (Specify amount to be paid by each party or the percentage or other formula agreed upon to determine the post-secondary education expense obligation agreed to by the parties): Case Name: Case Number: DECREE ON PARENTING PETITION NHJB-2078-F (11/25/2013) Page 3 of 3 Select one of the following: Both parties agree that this post-secondary e ducational 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-secondary 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 enforce the agreement described above, the parties shall participate in mediation. I/we request that the Cour t approve this decree. Date Signature of Petitioner Date Signature of Attorney/Witness for Petitioner Date Signature of Respondent Date Signature of Attorney/Witness for Respondent I certify 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