Fill and Sign the Deceased at the Time of Death Owned or the Ward Currently Owns the Certain Real Estate Form

NHJB-2134-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) MOTION AND LICENSE TO MO RTGAGE REAL ESTATE 1. Petitioner Name Telephone Mailing Address 2. Attorney Name Telephone Mailing Address Bar ID# 3. The deceased at the time of death owned, or the ward currently owns, the certain real estate identified below. (A ttach copy of legal description.) PROPERTY LOCATION % OWNED COUNTY BOOK/PAGE / / / 4. This real estate is currently valued at $ 5. It is necessary to ra ise the sum of $ for the following purpose: To pay just demands of the estate or debts of the ward To make necessary or desirable repa irs to preserve the real estate To facilitate settle ment of the estate To provide for ward's care , maintenance, rehabilitation, training or education To provide for care, maintena nce, rehabilitation, training or education of the ward's dependents Other (please specify) 6. The interests of the deceased's or ward's estate require that the fiduciary shall have power to mortgage this real estate to secure payment of a note in the amount of $ with interest at the rate of per ce nt (%) per year, with the following terms: 7. List resources available to pay mortgage 8. Have all persons interested in this matter consente d to this request? Yes (Attach consents.) No Case Name: Case Number: MOTION AND LICENSE TO MORTGAGE REAL ESTATE NHJB-2134-P (03/25/2013) Page 2 of 2 The petitioner asks that a licens e to mortgage this real estate for the su m of $ for the purpose stated above, and in ag reement with the laws of the State of New Hampshire, be issued. 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 the presence of a notarial officer) State of , County of This instrument was acknowledged bef ore me on by Date Petitioner My Commission Expires Affix Seal, if any Signature of Notarial Officer / Title ORDER AND LICENSE The motion is granted and the fiduciary is licensed upon the terms and conditions specified above. This license is only valid for 90 days from the date of this order. The fiduciary shall notify the court of the net proceeds of the mortgage within thirty ( 30) days following receipt of such proceeds. Date J udg e