THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) AFFIDAVIT OF ADMINISTRATOR Regarding Distribution of Insolvent Estate The administrator certifies that distribution was made in accordance with the Order on the Motion for Distribution of Insolvent Estate issued by this court. Date Date Administrator Signature (must be signed in presence of Notarial officer) Administrator Signature (must be signed in presence of Notarial officer) State of This instrument was acknowledged before me on County of by Date Administrator My Commission Expires Affix Seal, if any Signature of Notarial Officer / Title ORDER The administrator is discharged from all claims of creditors against the estate, with the exception of those claims covered by insurance for which the decedent was insured at the time of death. In such cases, recovery shall be limited to the coverage of the insurance policy or policies. Date Judge NHJB-2669-P (01/01/2011) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com