Notice Of Intent To Claim Paternity And Request For Hearing {NHJB-2194-FP}

THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) NOTICE OF INTENT TO CLAIM PATERNITY AND REQUEST FOR HEARING (RSA 170-B:5 and 170-B:6) 1. Alleged father of child Residence Address Mailing Address 2. Child's name Date of Birth 3. Mother of child named above Place of Birth Telephone I HEREBY CLAIM PATERNITY OF THE CHILD NAMED ABOVE AND REQUEST A HEARING TO PROVE THAT I AM THE FATHER OF THIS CHILD. Date Signature State of , County of by Signature of Notarial Officer / Title This instrument was acknowledged before me on My Commission Expires Affix Seal, if any NHJB-2194-FP (10/01/2006) (formerly AOC-205-003 and AOC-205-008) Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com