NHJB-2936-D (09/01/2018) Page 1 of 1 THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) AUTHORIZATION FOR REPRESENTATION UNDER RSA 503:11 (Including 223Corporate Resolution224 referred to in RSA 503:11) The undersigned hereby swears and affirms as follows: 1. My name is and I reside at 2. I am(specify one): A general partner of a partnership A member with management authority of a LLC A trustee of a trust An officer/director/secretary/other of the corporation listed below and am authorized by a corporate resolution to execute this document permitting representation of the corporation 3. The name and address of the entity: 4. The entity has duly authorized the following person to represent the entity in this matter Select one: Officer Employee Partner Owner Trustee of the entity 5. The entity will be bound by any agreement entered into by such person and will be subject to any order of the court in this matter. 6. The non-lawyer representative has signed the Rule 1.3D Statement attached. I certify that on this date I provided a copy of this document to (other party) or to (other party222s 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 Signature American LegalNet, Inc. www.FormsWorkFlow.com