Fill and Sign the And Assent Form

NHJB-2149-P (11/25/2013) Page 1 of 3 THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) Estate of MOTION FOR SUMMARY ADMINISTRATION AND ASSENT 1. Executor/Administrator Name Telephone Mailing Address Executor/Administrator Name Telephone Mailing Address 2. Attorney Name Telephone Mailing Address Bar ID# 3. The estate of the decedent has been open for at least 6 months. Yes No 4. To the best of my knowledge and belief, there are no outstanding debts, obligations or unpaid or unresolved claims attributable to the deceased’s estate. Yes No 5. No New Hampshire estate or inheritance taxes are due; OR all applicable New Hampshire estate and inheritance taxes have been paid and a certificate fr om the department of revenue administration under RSA 86:32 and/or 87:25 has been filed with the court. Yes No 6. No federal estate tax is due; OR the federal estate tax return has been filed and all taxes report ed thereon have been paid. Yes No 7. Court supervision of the administration of the estate is no longer necessary. Yes No 8. The administration of the estate will be completed without further court supervision in accordance with t he decedent’s will and applicable law. Yes No 9. Attached are either receipts (NHJB-2139-P) or ass ents (NHJB-2122-P) from all specific legatees and assent s from all other persons beneficially interested, as defined in RSA 550:12. Yes No 10. If there is real estate in this case , the court has been notified of the sale or transfer of the property by filing ei ther a Return/Notice of Sale form (NHJB-2126-P) or a Notice to To wns and Cities form (NHJB-2142-P). Yes No Case Name: Case Number: MOTION FOR SUMMARY ADMINISTRATION NHJB-2149-P (11/25/2013) Page 2 of 3 I certify that on this date I provided this document (s) to the parties who have filed an appearance for this case or who are otherwise interested parties by: Hand-delivery OR US Mail OR Email (E-mail only by prior agreement of the parties based on Circuit Court Administrative Order). Date Executor / Administrator (must be signed in presence of notarial officer) Date Executor / Administrator (must be signed in presence of notarial officer) State of , County of This instrument was acknowledged bef ore me on by Date Executor/Administrator(s) My Commission Expires Affix Seal, if any Signature of Notarial Officer / Title ORDER Motion for summary administration is granted. Motion for summary admi nistration is denied. Date Judge Case Name: Case Number: MOTION FOR SUMMARY ADMINISTRATION NHJB-2149-P (11/25/2013) Page 3 of 3 ASSENT FOR SUMMARY ADMINISTRATION The undersigned, being all the persons interested unde r the summary administration law, agree that further court supervision of the ad ministration of the estate is no longer necessary; do not request a final accounting; and request that the moti on for summary administration be granted. DATE PRINT NAME BELOW LINE ADDRESS WRITE SIGNATURE ON LINE