Fill and Sign the Residence City or Town Form

NHJB-2141-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 PETITION FOR SMALL ESTATE ADMINISTRATION Original Amended 1. Petitioner Name Telephone Mailing Address 2. Petitioner Name Telephone Mailing Address 3. Attorney Name Telephone Firm name Mailing Address Bar ID# 4. Deceased Name Date of Death Residence (city or town) 5. Deceased died: with will without will 6. Petitioner was: named not named in will of the deceased. 7. Petitioner’s relationship to deceased: Instructions for completing this section of the form. List only personal property such as cash, bank accounts, stocks, bonds, vehicles; no real estate is allowed on a small estate administration (aka voluntary administration). In the description of assets section, include specific identif ying information such as: model, vehicle identification number, serial numbers, name of bank and account numbers, certificate of deposit numbers, etc . If this is an amended petition, list the new assets followed by t he total value of the estate reported on the original petition. ASSETS DESCRIPTION OF ASSETS VALUE $ $ $ $ $ $ $ Total value of personal estate reported on original petition (if this is amended petition) Descriptions listed on previous petition(s). $ TOTAL PERSONAL ESTATE – NOT TO EXCEED $10,000 $ Case Name: Estate of Case Number: PETITION FOR SMALL ESTATE ADMINISTRATION NHJB-2141-P (03/25/2013) Page 2 of 2 Petitioner asks to serve as voluntary administrator of such estate and will administer the same according to law. 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 Petitioner Signature (must be signed in presence of notarial officer) Date Petitioner Signature (must be signed in presence of notarial officer) State of , County of This instrument was acknowledged bef ore me on by Date Petitioners My Commission Expires Affix Seal, if any Signature of Notarial Officer / Title ORDER The voluntary administrator's authorit y to administer is expressly limited only to asset(s) listed on this form. Out of the assets collected, the voluntary administrator shall pay debts and expenses of the estate in accordance with RSA 167:13, 554:19 or 557:34 as applicable, and shall take no fees for his/her services. A statement of administration must be filed no earlier than 60 days, nor later than 90 days, from the administrator's appointment. If an amended petition is filed, the original due dates are applicable. No distribution of the final balance shall be made unt il the statement is approved by the court. Any distribution should be according to the will of the deceased, if any, or if no will, in accordance with RSA 561. If letters testamentary or of administration are later granted, the voluntary administrator's power shall cease, and he/she shall deliver to the rightful executor or administrat or all assets and funds of the estate in his/her possession, and file a st atement of administration with the court. Petition for Small Estate Ad ministration is granted. Petition for Small Estate Administration is denied. Date Judge