THE STATE OF NEW HAMPSHIRE
Court Name: Case Name: Case Number:
Motion to Pay State Treasurer
For Property in Excess of $5,000
RSA 561:10 1. Petitioner Name Petitioner Name
2. Attorney Name 4. I have the following sum of money: It belongs to: 5. That person's place of residence is unknown, and I have done everything I can to find that
person or his or her heirs; or, the person entitled to the sum has refused it.
The petitioner asks to be authorized by the court to pay the sum to the State Treasurer. Such payment would be a discharge of the administrator's duties as they relate to this property. Capacity
3. I have settled the account of the administration for this estate.
State of This instrument was acknowledged before me on My Commission Expires Affix Seal, if any
, County of by
Signature of Notarial Officer / Title
ORDER Motion to pay the sum of Treasurer is granted. A receipt must be filed within Motion to pay the sum of Treasurer is not granted. to the New Hampshire State days of this order. to the New Hampshire State
NHJB-2499-P (02/01/08) (formerly AOC 115-003)
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