Instructions for Form DSSP256 "Criminal History Record Information Release Authorization Form" - New Hampshire

This document contains official instructions for Form DSSP256, Criminal History Record Information Release Authorization Form - a form released and collected by the New Hampshire Department of Safety. An up-to-date fillable Form DSSP256 is available for download through this link.

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Download Instructions for Form DSSP256 "Criminal History Record Information Release Authorization Form" - New Hampshire

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Instructions for completing
Division of State Police
Criminal Record Release Authorization
Form use This is not a Circuit Court form. However, this form is required in minor and adult
guardianships and some adoption cases when completing background checks on the
proposed guardians or adoptive parents.
Section I
Enter your complete Name on the first line in the following order: Your Last Name, your
Maiden Name or an Alias Name, if applicable, Your First Name and your Middle Initial.
Enter your complete Address including zip code on the second line.
On the third line, enter your Date of birth and Sex.
On the fourth line, enter your Hair color and Eye color
On the fifth line, enter your Driver’s License Number and the State in which you have a
driver’s license.
Purpose for Record: In Other enter the specific court case (i.e. adult guardianship, adoption or
minor guardianship)
You will sign the form on the Your Signature line, and date it in the appropriate space to the
right.
Section II
In this section you are authorizing the release of your criminal record convictions, if any, to the court
named.
On the first line, enter the name of the Circuit Court Probate Division or Family Division who will
receive the record.
On the second line, enter the address of the Circuit Court Probate Division or Family Division
location including zip code.
Signature Section
You will sign the form on the Signature line, and date it in the appropriate space to the right. Notary
will not be required pursuant to RSA 106-B:14, IC effective Jan. 1 2018 when electronically filed in
Guardianship cases.
NOTE: Courts are exempt from the fee as listed on the form. Parties do not have to pay if
filing this form in a court case.
Review the completed form for accuracy prior to filing it with the court. If completing this form on-line,
some fields may be filled in automatically based on entries in other fields. If more space is needed for
any question, please attach additional sheets of paper.
Instructions for completing
Division of State Police
Criminal Record Release Authorization
Form use This is not a Circuit Court form. However, this form is required in minor and adult
guardianships and some adoption cases when completing background checks on the
proposed guardians or adoptive parents.
Section I
Enter your complete Name on the first line in the following order: Your Last Name, your
Maiden Name or an Alias Name, if applicable, Your First Name and your Middle Initial.
Enter your complete Address including zip code on the second line.
On the third line, enter your Date of birth and Sex.
On the fourth line, enter your Hair color and Eye color
On the fifth line, enter your Driver’s License Number and the State in which you have a
driver’s license.
Purpose for Record: In Other enter the specific court case (i.e. adult guardianship, adoption or
minor guardianship)
You will sign the form on the Your Signature line, and date it in the appropriate space to the
right.
Section II
In this section you are authorizing the release of your criminal record convictions, if any, to the court
named.
On the first line, enter the name of the Circuit Court Probate Division or Family Division who will
receive the record.
On the second line, enter the address of the Circuit Court Probate Division or Family Division
location including zip code.
Signature Section
You will sign the form on the Signature line, and date it in the appropriate space to the right. Notary
will not be required pursuant to RSA 106-B:14, IC effective Jan. 1 2018 when electronically filed in
Guardianship cases.
NOTE: Courts are exempt from the fee as listed on the form. Parties do not have to pay if
filing this form in a court case.
Review the completed form for accuracy prior to filing it with the court. If completing this form on-line,
some fields may be filled in automatically based on entries in other fields. If more space is needed for
any question, please attach additional sheets of paper.