Instructions
Clear Form
THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us
Court Name: Case Name: Case Number:
(if known)
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
Capacity Telephone
3. I have settled the account of the administration for this estate.
Date
Petitioner Signature
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
Date
NHJB-2499-P (02/01/08) (formerly AOC 115-003)
Judge
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