Termination of Parental Rights

Termination of Parental Rights

Complete this form to provide all information required for the Nevada Petition to Terminate Parental Rights. Please answer all questions accurately.
NRS240A DISCLOSURE - Read Carefully.

I, DEBORAH BARNHART, DOING BUSINESS AS DPS O FNORTHERN NEVADA, AM NOT AN ATTORNEY IN THE STATE OF NEVADA. I AM NOT AUTHORIZED TO GIVE LEGAL ADVICE OR LEGAL REPRESENTATION. I MAY NOTACCEPT FEES FOR GIVING LEGAL ADVICE OR LEGAL REPRESENTATION.
Petitioner's (Your) Information

Enter your personal and contact information.
Full legal name*

First NameMiddle NameLast NameSuffix
Has your name changed since the last Court Order? (if applicable)*

YesNo
If yes, list previous name

First NameMiddle NameLast NameSuffix
Home address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Is your mailing address the same as your home address?

Mailing address same as home address
Mailing address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Telephone number*
Please enter a valid phone number.
Email address*
example@example.com
Relationship to the child*

MotherFatherGuardianOther (explain)
Court Information

Enter the court details for this petition.
County*
Case number (if known)
Department number (if known)
Respondent – Person Whose Parental Rights You Want to Terminate

Enter information forthe person whose parental rights you seek to terminate.
Respondent's Full Name

First NameMiddle NameLast NameSuffix
Has the Respondent's name changed since the last Court Order? (if applicable)*

YesNo
If yes, list previous name

First NameMiddle NameLast NameSuffix
Home address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mailing address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Telephone number
Please enter a valid phone number.
Email address
example@example.com
Relationship to the child*

MotherFatherGuardianOther (explain)
If the Respondent's address unknown, nearest known adult relative in Nevada (name, relationship, address)
Respondent's Attorney Information

Provide details if the respondent has an attorney.
Does the respondent have an attorney?*

YesNo
Attorney full name

First NameLast Name
Law firm (optional)
Attorney mailing address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Attorney phone number
Please enter a valid phone number.
Attorney email address
example@example.com
Child(ren) Information

Enter information for each child.
First Child's Name

First NameMiddle NameLast NameSuffix
Date of Birth

MonthDayYear
Date
Has the child lived in Nevada for the last six months or since birth? If not, explain where the child has lived under 'Other'*

YesNoOther
Second Child's Name

First NameMiddle NameLast NameSuffix
Date of Birth

MonthDayYear
Date
Has the child lived in Nevada for the last six months or since birth? If not, explain where the child has lived under 'Other'*

YesNoOther
Third Child's Name

First NameMiddle NameLast NameSuffix
Date of Birth

MonthDayYear
Date
Has the child lived in Nevada for the last six months or since birth? If not, explain where the child has lived under 'Other'*

YesNoOther
Fourth Child's Name

First NameMiddle NameLast NameSuffix
Date of Birth

MonthDayYear
Date
Has the child lived in Nevada for the last six months or since birth? If not, explain where the child has lived under 'Other'*

YesNoOther
Fifth's Child Name

First NameMiddle NameLast NameSuffix
Date of Birth

MonthDayYear
Date
Has the child lived in Nevada for the last six months or since birth? If not, explain where the child has lived under 'Other'*

YesNoOther
If more than five children, list the remaining children below (Full name and date of birth is required)
Other Court Cases Involving the Child/ren

Disclose any other legal matters involving the child/ren.
Have you participated in any other case involving the child/ren?*

YesNo
If yes, provide details (state, court name, case number, type of case, date of custody order)
Do you know of any other case that could affect this case?*

YesNo
If yes, provide details (state, court, parties, case number, type of case)
Is anyone else claiming custody or visitation rights?*

YesNo
If yes, provide names and addresses
Do you want to terminate rights of any unknown parent?*

YesNoDoes not apply
Does the child/ren have a legal guardian?*

YesNo
If yes, guardian name and address
Public Assistance

Disclose public assistance received by you or the child.
Do you receive public assistance?*

YesNo
Does the child/ren receive public assistance?*

YesNo
Grounds for Termination

Select all grounds for termination that apply. Provide explanations as required.
Grounds for Termination (select all that apply)*

AbandonmentNeglectUnfitnessFailure of parental adjustmentRisk of harmToken effortsSexual assault resulting in conception
If Abandonment is selected: Date last support/communication and explanation
If Token efforts is selected: Explain
If Neglect or Unfitness is selected, answer the following for each (Yes/No and explanation):

Complete these sub-questions for Neglect or Unfitness grounds.
Does the Respondent have a diagnosed emotional or mental illness?

YesNo
Explanation of emotional or mental illness
Does the Respondent exhibit abuse or cruelty?

YesNo
Explanation of abuse or cruelty
Has the Respondent been involved in human trafficking / forced labor?

YesNo
Explanation of human trafficking / forced labor
Has (or is) the Respondent suffering from substance abuse?

YesNo
Explanation of substance abuse
Has the Respondent failed to provide necessities?

YesNo
Explanation for failure to provide necessities
Does the Respondent hava a felony conviction?

YesNo
If yes, case number and court
Has the respondent caused serious injury or death of another child?

YesNo
Explanation for serious injury or death of another child
Have you or the Respondent undergone any familyreunification efforts through an agency or councellor?

YesNo
Explanation for reunification efforts by agency/councellor
Best Interest of the Child/ren

Explain why terminating parental rights is in the best interest of the child/ren.
Explain why termination is in the best interest of the child/ren*
Indian Child Welfare Act (ICWA)

Disclose knowledge of Native American heritage.
Do you have reason to know the child is an Indian child?*

YesNo
Unborn Child (if applicable)

Complete only if you are filing regarding an unborn child.
Are you filing regarding an unborn child?*

YesNo
If yes, other parent name

First NameLast Name
If yes, other parent residence

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Expected due date

MonthDayYear
Date
Prior Court Orders Upload

Upload the most recent/last court order (PDF or image).
Upload the most recent or last court order (PDF or image)

Cancelof
NRS240A DISCLOSURE - Acknowledgment

Please review and confirm the information below
I, DEBORAH BARNHART, DOING BUSINESS AS DPS OF NORTHERN NEVADA, AM NOT AN ATTORNEY IN THE STATE OF NEVADA. I AM NOT AUTHORIZED TO GIVE LEGAL ADVICE OR LEGAL REPRESENTATION. I MAY NOT ACCEPT FEES FOR GIVING LEGAL ADVICE OR LEGAL REPRESENTATION.*

I understand that Deborah Barnhart, dba DPS of Northern Nevada, is not an attorney and is acting solely as a legal document preparer.
Typed full name (as signature)*

First NameMiddle NameLast NameSuffix
Date*

MonthDayYear
Date
Should be Empty:

Termination of Parental Rights

NRS240A DISCLOSURE - Read Carefully.

Petitioner's (Your) Information

Court Information

Respondent – Person Whose Parental Rights You Want to Terminate

Respondent's Attorney Information

Child(ren) Information

Other Court Cases Involving the Child/ren

Public Assistance

Grounds for Termination

If Neglect or Unfitness is selected, answer the following for each (Yes/No and explanation):

Best Interest of the Child/ren

Indian Child Welfare Act (ICWA)

Unborn Child (if applicable)

Prior Court Orders Upload

NRS240A DISCLOSURE - Acknowledgment