Free Receipt - New Hampshire

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THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us

Court Name: Case Name: Case Number:
(if known)

RECEIPT

1.

RECEIVED FROM Executor Administrator Special Administrator

, serving as:

Ancillary Executor or Administrator Administrator With Will Annexed Guardian 2. Conservator

Administrator De Bonis Non Trustee

The sum of money, personal property at inventory value thereof, amounting to $ , in Distribution(s) according to terms of trust Distributive share upon termination of trust Balance upon termination of guardianship Balance upon termination of conservatorship Distributive share of decedent's estate Residuary share under decedent's will Money bequeathed under decedent's will Personal property bequeathed under decedent's will Other (specify) full partial satisfaction of the following:

Date

Recipient

Print Name of Recipient

NHJB-2139-P (10/01/2006) (formerly AOC 136-003)

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