Extra Page For Petitions (UCCJEA) {NHJB-2656-DFPS}

THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) EXTRA PAGE FOR UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) INFORMATION Petition/Response you are attaching this extra page to: List the places where the minor child/ren of the parties has/have lived in the last five years and the names of the people they lived with at that time. Start with where the child lives now and work backward in time. Dates From/To Town/City, State Parent(s)/Caretaker Current Address/Contact Address of Parent/Caretaker Which Child/ren I swear or affirm that the foregoing information is true and correct to the best of my knowledge. Date Name of Person Submitting This Extra Page Signature State of This instrument was acknowledged before me on My Commission Expires Affix Seal, if any NHJB-2656-DFPS (12/01/2010) , County of by Signature of Notarial Officer / Title American LegalNet, Inc. www.FormsWorkFlow.com