Form NHJB-2681-F "Statement for Payment - Divorce and Parenting" - New Hampshire

What Is Form NHJB-2681-F?

This is a legal form that was released by the New Hampshire Judicial Branch - a government authority operating within New Hampshire. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2020;
  • The latest edition provided by the New Hampshire Judicial Branch;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form NHJB-2681-F by clicking the link below or browse more documents and templates provided by the New Hampshire Judicial Branch.

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Download Form NHJB-2681-F "Statement for Payment - Divorce and Parenting" - New Hampshire

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Clear Form
THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us
Court Name:
Case Name:
Case Number:
STATEMENT FOR PAYMENT - DIVORCE AND PARENTING
Name of Payee
Name of Mediator if different from Payee
Street Address of Payee
Vendor Number
City
State
Zip
I filed a Mediation Report for the session held on
. I attach my Appointment
and seek payment for the outcome indicated below:
Outcome #1: The mediation session was held.
The petitioner’s mediation fee of $
is to be paid by:
Grant
Fund (with children)
Fund (without children)
Paid mediator directly; no reimbursement requested
The respondent’s mediation fee of $
is to be paid for by:
Grant
Fund (with children)
Fund (without children)
Paid mediator directly; no reimbursement requested
Outcome #2: A party or parties did not appear.
A.
The (check one)
Petitioner
Respondent did not appear.
The party owes: $
($120, unless otherwise ordered by the Court) to be paid by the
fund. Note: the grant cannot pay these fees. Parties who received the grant shift to fund.
B.
Neither party appeared
The petitioner owes: $
($60, unless otherwise ordered by the Court) to be paid by
The fund OR
The party, directly to the mediator.
The respondent owes: $
($60, unless otherwise ordered by the Court) to be paid by
The fund OR
The party, directly to the mediator.
Outcome #3: Without good cause, a party or parties cancelled or rescheduled with less than 2
business days’ notice.
A.
The (check one)
Petitioner
Respondent cancelled or rescheduled untimely.
The party owes: $
($120, unless otherwise ordered by the Court) to be paid by the
fund. Note: the grant cannot pay these fees. Parties who received the grant shift to fund.
B.
Both parties cancelled or rescheduled untimely.
The petitioner owes: $
($60, unless otherwise ordered by the Court) to be paid by
The fund OR
The party, directly to the mediator.
The respondent owes: $
($60, unless otherwise ordered by the Court) to be paid by
The fund OR
The party, directly to the mediator.
I attended First Appearance as assigned on
and received no Appointments.
I request $60.
Date
Signature of Mediator
NHJB-2681-F (01/01/2020)
(for court use only) Total Authorized for Payment: $
Clear Form
THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us
Court Name:
Case Name:
Case Number:
STATEMENT FOR PAYMENT - DIVORCE AND PARENTING
Name of Payee
Name of Mediator if different from Payee
Street Address of Payee
Vendor Number
City
State
Zip
I filed a Mediation Report for the session held on
. I attach my Appointment
and seek payment for the outcome indicated below:
Outcome #1: The mediation session was held.
The petitioner’s mediation fee of $
is to be paid by:
Grant
Fund (with children)
Fund (without children)
Paid mediator directly; no reimbursement requested
The respondent’s mediation fee of $
is to be paid for by:
Grant
Fund (with children)
Fund (without children)
Paid mediator directly; no reimbursement requested
Outcome #2: A party or parties did not appear.
A.
The (check one)
Petitioner
Respondent did not appear.
The party owes: $
($120, unless otherwise ordered by the Court) to be paid by the
fund. Note: the grant cannot pay these fees. Parties who received the grant shift to fund.
B.
Neither party appeared
The petitioner owes: $
($60, unless otherwise ordered by the Court) to be paid by
The fund OR
The party, directly to the mediator.
The respondent owes: $
($60, unless otherwise ordered by the Court) to be paid by
The fund OR
The party, directly to the mediator.
Outcome #3: Without good cause, a party or parties cancelled or rescheduled with less than 2
business days’ notice.
A.
The (check one)
Petitioner
Respondent cancelled or rescheduled untimely.
The party owes: $
($120, unless otherwise ordered by the Court) to be paid by the
fund. Note: the grant cannot pay these fees. Parties who received the grant shift to fund.
B.
Both parties cancelled or rescheduled untimely.
The petitioner owes: $
($60, unless otherwise ordered by the Court) to be paid by
The fund OR
The party, directly to the mediator.
The respondent owes: $
($60, unless otherwise ordered by the Court) to be paid by
The fund OR
The party, directly to the mediator.
I attended First Appearance as assigned on
and received no Appointments.
I request $60.
Date
Signature of Mediator
NHJB-2681-F (01/01/2020)
(for court use only) Total Authorized for Payment: $