NHJB-2089-DFSSUP (03/25/2013) Page 1 of 1 THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH htt p ://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) MOTION FOR AUTHORIZATION TO OBTAIN SERVICES OTHER THAN COUNSEL NOW COMES the defendant in the above captioned matter and requests: TO BE FILLED IN BY DEFENDANT'S LAWYER: 1. Because of the seriousness and complexity of the above captioned matter, it is necessary in the preparation of an adequate defense that the defendant be authorized to retain the services of a(n): for the purpose of: 2. The firm(s) of has indicated a willingness to provide this assistance. 3. The estimated fee for this service will be $ 4. Information regarding hearing to be transcribed (to be completed when requesting a transcript): Court Name: Case Name: Case Number(s): Date(s): WHEREFORE, the defendant requests that the Court authorize the services as stated above, that fees in the amount of $ be allowed by the Court, and for such other and further relief as may be right and just. Respectfully submitted, Date Signature of Defendant/Defense Attorney CERTIFICATION: I certify that on this date I provided a copy of this document to the Prosecutors office 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 of Defendant/Defense Attorney APPROVAL OF PRESIDING JUDGE: I, , Approve Deny the above request. Print name of Judge Services not to exceed $ , all or part of which may be ordered reimbursed by the liable party at the conclusion of the case. Date Signature of Judge American LegalNet, Inc. www.FormsWorkFlow.com