NHJB-2798-DFS (01/25/2017) THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us NHJB Central Processing Center 1 Granite Place, Suite N400 Concord, NH 03301 Telephone: (855) 212-1234TTY/TDD Relay: (800) 735-2964http://www.courts.state.nh.us RECORDS RESEARCH AND PAYMENT FORM Court Name: Name of Person/Company Requesting Research: Address: Address City/Town State Zip Email results Yes No (If no, include self-addressed stamped envelope): Email Address Phone Number: Date and Time of Request: am pm (Date) (Time) SEARCH TYPE RESULT (court use only) Name Date of Birth Criminal Civil Other Electronic 1992 & forward Manual Prior to 1992 No Record See Attached 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. American LegalNet, Inc. www.FormsWorkFlow.com Name of Person/Company Requesting Research: Phone Number: Date and Time of Request: (Date) (Time) RECORDS RESEARCH AND PAYMENT FORM NHJB-2798-DFS (01/25/2017) Electronic Searches: 5 names or less ($20.00 per name). Additional names, add $5.00 per name. (Example: 3 names = $60.00; 5 names = $100; 25 names = $200.00) Number of Requests Made: ***Total Amount Due: $ Manual Searches: Any record search that includes cases prior to 1992: 5 names or less ($20.00 per name). Additional names, add $5.00 per name. NOTE: If the time spent on a manual search exceeds one hour, any additional time spent on the search will be billed $25.00/hour in addition to the initial fee of $20.00 per name. You will be billed separately for any time spent on manual searches beyond one hour. Please mail this completed form with payment to: New Hampshire Judicial Branch Administrative Offices Attention: Central Processing Center 1 Granite Place, Suite N400 Concord, New Hampshire 03301 PAYMENT METHOD: Check for ***Total Amount Due is enclosed (checks made payable to NHJB Central Processing Center) OR Charge ***Total Amount Due to the following: VISA MasterCard Discover CARD NUMBER: - - - Expiration Date: / Name: Please print as shown on credit card Date Signature American LegalNet, Inc. www.FormsWorkFlow.com