Free Investment Certification - New Hampshire

Instructions

Clear Form

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

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

INVESTMENT CERTIFICATION
I,
(Name)

,
(Official capacity or position)

of
(Name of Institution)

,
(Address of Institution)

, County

do hereby certify and attest that in accordance with the decree of the Probate Court dated
(Guardian name)

, the following deposits/investments were made by , as guardian of
(Ward name)

Form of Deposit/ Investment

Account or Certificate Number

Date of Deposit/ Investment $ $ $

Amount

I further certify and attest that the foregoing deposits/investments have been restricted with notation recited on its/their face, that no withdrawal, encumbrance or other disposition may be made without express written court order; and a copy of the referenced court decree has been made part of the investment records. My telephone number is

.

Date

Signature of official

State of This instrument was acknowledged before me on My Commission Expires Affix Seal, if any

, County of by
Signature of Notarial Officer / Title

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NHJB-2167-P (10/01/2006) (formerly AOC-213-003) Page 1 of 1