THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) Waiver by Surviving Spouse RSA 560:10 1. 2. 3. Surviving Spouse Name Attorney Name Deceased Name Residence (street, city or town) Telephone Telephone Date of Death 4. Date of marriage of surviving spouse and deceased I am the surviving spouse of the above named deceased person. I hereby waive my homestead rights, if any, and the provisions of the will of the deceased in my favor, if any, for the purpose of receiving my statutory share of the deceased's estate. Date Surviving Spouse 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 NHJB-2498-P (02/01/2008) (formerly AOC 137-003) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com