Receipt for Custody of Exhibits UNITED STATES DISTRICT COURT District of New Hampshire _____________________________ Plaintiff v. _____________________________ Defendant Case Number: ________________________ RECEIPT FOR CUSTODY OF EXHIBITS I hereby acknowledge receipt of the following exhibits: Exhibit Number Description of Exhibit These exhibits shall be preserved and returned in the form in which they are received. Date: _______________ __________________________________ Signature of Attorney or Representative Print: __________________________________ Name __________________________________ Title __________________________________ Address __________________________________ Phone USDCNH-118 (1-10) American LegalNet, Inc. www.FormsWorkFlow.com