p wwwcourtsstatenhusCase Name Case Number if known CHINS PETITION 1 Child146s name Gender M F Date of Birth Race petitioner check all that apply American IndianAla ID: 244366
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THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH htt p ://www.courts.state.nh.us Case Name: Case Number: (if known) CHINS PETITION 1. Child’s name a school district official or truant officer: Per RSA 169-D:5 I(a) and RSA 169-D:2, II(a) where the child is subject to compulsory school attendance, and is habitually, willfully, and without good and sufficient cause truant from school. All steps in the school district’s intervention process under RSA to filing this petition. a parent, legal guardian, or custodian, school official, or law enforcement officer pursuant to NHJB-2840-DF (08/01/2015) Case Name: Case Number: CHINS PETITION Date(s) and time(s) of child’s actions alleged to be the basis of this petition Location of the child’s alleged actions Details or facts of the child’s alleged actions: Voluntary services have been attempted. See attached statement from DCYF. Explain the nature of voluntary services attempted. Voluntary services have not been attempted. See attached statement from DCYF Court compulsion is necessary for the following reasons: I swear or affirm that the foregoing information is true and correct to the best of my knowledge. Petitioner Signature State of , County of This instrument was acknowledged before me on My Commission Expires Signature of Notarial Officer / Title at a.m./p.m. at person(s) having custody or Date Clerk/Deputy T INFORMATION AND FINANCIAL OBLIGATIONS NHJB-2840-DF (08/01/2015) Case Name: Case Number: CHINS PETITION GHTS AND FINANCIAL OBLIGATIONS Appearance, will appoint an attorney to represent you. In the event that you need additional time to obtain an attorney or prepare a response to this petition, application should be made to the Court for an extension of time. You are fu to remain silent and need not stated in the petition. Your silence even in the face of an accuIn accordance with RSA 169-D:29, parents and others chargeable by law for the child’s support and necessities are required to reimbursamount that you will be required towill be based on your ability to pay. You have contact your insurance carrier within 48 hours to see rance coverage is available, you ly with their requirements NHJB-2840-DF (08/01/2015)