Fill and Sign the Motion to Determine that an Estate is Insolvent Form

NHJB-2667-P (03/25/2013) Page 1 of 2 THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) Estate of MOTION TO DETERMINE THAT AN ESTATE IS INSOLVENT (RSA 554:19-b) 1. Administrator Name Telephone Mailing Address Administrator Name Telephone Mailing Address 2. Attorney Name Telephone Mailing Address Bar ID# 3. Value of estate assets Real estate value (as of the date of death) $ Personal estate value (as of the date of death) $ Trust value available to satisf y creditors and claims $ Total Value of Estate and Trust Assets $ 4. List the name and address of each known creditor and amount of each claim, and all administrative expenses. (Attach addi tional sheets of paper if necessary.) CREDITOR’S NAME AND ADDRESS AMOUNT OF EXPENSE/CLAIM $ $ $ $ $ $ $ $ Total debts against the estate and administrative expenses $ 0.00 0.00 Case Name: Estate of Case Number: MOTION TO DETERMINE THAT AN ESTATE IS INSOLVENT NHJB-2667-P (03/25/2013) Page 2 of 2 Based on the total value of the estate and list of debts and expenses of the estate, I request that the court allow the estate to be administered as insolvent. 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, including all known creditors, by: Hand-delivery OR US Mail OR Email (E-mail only by prior agreement of the parti es based on Circuit Court Administrative Order) . Date Administrator Signature Date Administrator Signature IMPORTANT NOTICE To Beneficially Interested Persons This motion may be approved by the Probate Division unless a written objection, containing the specific factual or legal basis for the objection, is filed within 10 days after the date the motion is filed in the Probate Division. Failure to file an objection may forfeit your right to a hearing concerning the motion or your objection, and the Probate Division may then act without a hearing or any further notice to you. ORDER Motion is granted. All actions and suits against the deceased or the administrator of the estate shall be stayed. Filing of inventory is waived not waived Filing of account(s) is waived not waived Motion is denied. Date Judge