"Reduced Fee Request Form" - New Hampshire

Reduced Fee Request Form is a legal document that was released by the New Hampshire Department of Safety - a government authority operating within New Hampshire.

Form Details:

  • Released on January 1, 2009;
  • The latest edition currently provided by the New Hampshire Department of Safety;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New Hampshire Department of Safety.

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New Hampshire Department of Safety
DIVISION OF STATE POLICE
Central Repository for Criminal Records
33 Hazen Drive, Concord, NH 03305
REDUCED FEE REQUEST FORM
SECTION 5703.07 Fee Exemption of the Rules and Regulations for the Operation of the
Central Repository: (d) Volunteers for public or private not-for-profit agencies that
provide services to the elderly, the disabled or children shall be charged $10.00 for each
criminal record check requested.
PLEASE PRINT OR TYPE CLEARLY
NAME
___________________________________________________________________________
ORGANIZATION OR AGENCY
ADDRESS
_______________________________________________________________________
STREET
CITY
STATE
ZIP CODE
__________________
_______________
TELEPHONE NUMBER
FAX NUMBER
IS AGENCY OR ORGANIZATION NON-PROFIT?
YES _____
NO _____
IS THE REQUESTED PERSON(S) A VOLUNTEER?
YES _____
NO _____
WILL THE SERVICES BE TO THE ELDERLY, THE
DISABLED, OR CHILDREN?
YES _____
NO _____
The Identity of the volunteer for whom this reduced fee is requested:
______________________________________________
who will be working with:
NAME OF VOLUNTEER (please print)
Elderly
Disabled
Children
THE ABOVE INFORMATION IS ACCURATE AND TRUE:
Authorized Signature________________________________________ Date____________
FOR THE AGENCY OR ORGANIZATION
Signed under penalty of unsworn falsification pursuant to RSA 641:3
NOTE: This form must be accompanied by a completed Criminal Record Release Authorization Form.
Effective 1/01/2009
New Hampshire Department of Safety
DIVISION OF STATE POLICE
Central Repository for Criminal Records
33 Hazen Drive, Concord, NH 03305
REDUCED FEE REQUEST FORM
SECTION 5703.07 Fee Exemption of the Rules and Regulations for the Operation of the
Central Repository: (d) Volunteers for public or private not-for-profit agencies that
provide services to the elderly, the disabled or children shall be charged $10.00 for each
criminal record check requested.
PLEASE PRINT OR TYPE CLEARLY
NAME
___________________________________________________________________________
ORGANIZATION OR AGENCY
ADDRESS
_______________________________________________________________________
STREET
CITY
STATE
ZIP CODE
__________________
_______________
TELEPHONE NUMBER
FAX NUMBER
IS AGENCY OR ORGANIZATION NON-PROFIT?
YES _____
NO _____
IS THE REQUESTED PERSON(S) A VOLUNTEER?
YES _____
NO _____
WILL THE SERVICES BE TO THE ELDERLY, THE
DISABLED, OR CHILDREN?
YES _____
NO _____
The Identity of the volunteer for whom this reduced fee is requested:
______________________________________________
who will be working with:
NAME OF VOLUNTEER (please print)
Elderly
Disabled
Children
THE ABOVE INFORMATION IS ACCURATE AND TRUE:
Authorized Signature________________________________________ Date____________
FOR THE AGENCY OR ORGANIZATION
Signed under penalty of unsworn falsification pursuant to RSA 641:3
NOTE: This form must be accompanied by a completed Criminal Record Release Authorization Form.
Effective 1/01/2009