THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) LANDLORD/TENANT ACTION NOTICE OF INTENT TO APPEAL NOW COMES Landlord/Tenant , and hereby gives to the New Hampshire Supreme Court. Date Notice of Intent to Appeal this court's ruling of I understand that in order to appeal to the New Hampshire Supreme Court, I must file a Notice of Appeal in that court no later than thirty (30) days from the date of the this court's written notice of judgment. If I fail to do so, the court order will become final. I further understand that in a landlord/tenant action, an appeal by the tenant may be dismissed if the tenant fails to make any rental payments as they become due after this notice has been filed. If the reason for possessory action was for non-payment of rent, the tenant must pay, weekly to the court, the amount of rent determined by the court. This weekly rent payment must be made on the same day of the week on which the Notice of Intent to Appeal form was filed. Landlord/Tenant Signature I certify that on this date I provided a copy of this document to (other party) or to (other party's attorney) by: Hand-delivery OR US Mail OR E-mail (E-mail only by prior agreement of the parties based on Circuit Court Administrative Order). Date Landlord/Tenant Signature Landlord/Tenant (printed name) NHJB-2085-DP (03/25/2013) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com