THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) Estate of MOTION FOR DISTRIBUTION OF INSOLVENT ESTATE 1. Administrator Name Mailing Address Administrator Name Mailing Address 2. Attorney Name Mailing Address 3. Value of estate assets Real estate value (as of the date of death) Personal estate value (as of the date of death) Additional value since date of death (ex. Interest on accounts, refund checks, gain or loss on sale) Telephone Telephone Telephone Bar ID# $ $ $ $ $ Trust value available to satisfy creditors and claims Total Value of Estate and Trust Assets 4. 5. Payment of the claims will be made in accordance with the priorities outlined in RSA 554:19. No distribution shall be made without prior court approval. Distribution is requested as follows: (Attach additional sheets of paper if necessary) NAME AMOUNT OF EXPENSE/ AMOUNT CLAIMED $ $ $ $ $ $ $ TOTAL AMOUNT TO BE PAID $ $ $ $ $ $ $ $ NHJB-2668-P (03/25/2013) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case Name: Estate of Case Number: MOTION FOR DISTRIBUTION of INSOLVENT ESTATE The administrator requests that an order of distribution be made to those persons named in such sums as set forth above. I certify that on this date I provided this document(s) to the parties who have filed an appearance for Hand-delivery this case or who are otherwise interested parties, including all known creditors, by: OR US Mail OR Email (E-mail only by prior agreement of the parties based on Circuit Court Administrative Order). Date Administrator Signature Date Administrator Signature IMPORTANT NOTICE To Beneficially Interested Persons This motion may be approved by the Probate Division unless a written objection, containing the specific factual or legal basis for the objection, is filed within 30 days after the date the motion is filed in the Probate Division. Failure to file an objection may forfeit your right to a hearing concerning the motion or your objection, and the Probate Division may then act without a hearing or any further notice to you. ORDER Motion is granted and the court orders that distribution be made as specified in the foregoing motion no sooner than 30 days; the Administrator shall thereafter file an Affidavit of Administrator with the court. Motion is denied. Date Judge NHJB-2668-P (03/25/2013) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com