THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) Estate of MOTION TO DETERMINE THAT AN ESTATE IS INSOLVENT (RSA 554:19-b) 1. Administrator Name Mailing Address Administrator Name Mailing Address 2. Attorney Name Mailing Address 3. Value of estate assets Real estate value (as of the date of death) Personal estate value (as of the date of death) Trust value available to satisfy creditors and claims Total Value of Estate and Trust Assets 4. $ $ $ $ Telephone Bar ID# Telephone Telephone List the name and address of each known creditor and amount of each claim, and all administrative expenses. (Attach additional sheets of paper if necessary.) CREDITOR'S NAME AND ADDRESS AMOUNT OF EXPENSE/CLAIM $ $ $ $ $ $ $ $ Total debts against the estate and administrative expenses $ NHJB-2667-P (03/25/2013) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case Name: Estate of Case Number: MOTION TO DETERMINE THAT AN ESTATE IS INSOLVENT Based on the total value of the estate and list of debts and expenses of the estate, I request that the court allow the estate to be administered as insolvent. I certify that on this date I provided this document(s) to the parties who have filed an appearance for Hand-delivery this case or who are otherwise interested parties, including all known creditors, by: OR US Mail OR Email (E-mail only by prior agreement of the parties based on Circuit Court Administrative Order). Date Date Administrator Signature Administrator Signature IMPORTANT NOTICE To Beneficially Interested Persons This motion may be approved by the Probate Division unless a written objection, containing the specific factual or legal basis for the objection, is filed within 10 days after the date the motion is filed in the Probate Division. Failure to file an objection may forfeit your right to a hearing concerning the motion or your objection, and the Probate Division may then act without a hearing or any further notice to you. ORDER Motion is granted. All actions and suits against the deceased or the administrator of the estate shall be stayed. Filing of inventory is Filing of account(s) is waived waived not waived not waived Motion is denied. Date Judge NHJB-2667-P (03/25/2013) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com