Assent
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THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) ASSENT The undersigned, being all the persons interested, assent to the and request that it be allowed. DATE PRINT NAME BELOW LINE WRITE SIGNATURE ON LINE ADDRESS NHJB-2121-P (10/01/2006) (formerly AOC 011-003) Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com