THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) Estate of DECLINATION 1. Named Fiduciary Mailing address Telephone number 2. Named Fiduciary Mailing address Telephone number 3. Deceased Name Date of Death Residence (city or town) The undersigned was/were named executor(s)/trustee(s) in the last will and testament of the deceased, and hereby decline(s) to so serve. Date Named Fiduciary Date Named Fiduciary NHJB-2123-P (10/01/2006) (formerly AOC 042-003) Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com