THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) Guardianship of PETITION AND AFFIDAVIT FOR EXPEDITED HEARING (RSA 464-A:4, IV) Always complete items 1 and 2 below. 1. 2. I, expedited hearing under RSA 464-A:4, IV, and state that: under oath, hereby request an In my/our opinion, an expedited hearing for the finding of incapacity and appointment of a guardian of the person and estate, or the person, or estate, is necessary for the following reason(s): MEDICAL EMERGENCY: If the petitioner is a physician and this petition & affidavit is for a medical emergency, complete items 3, 4 and 5 below. 3. 4. 5. Physician Name I am a physician at I am the physician for I certify that on this date I provided this document(s) to the parties who have filed an appearance for this case or who are otherwise interested parties by: Hand-delivery OR US Mail OR Email (E-mail only by prior agreement of the parties based on Circuit Court Administrative Order). Date Petitioner or Physician Signature (must be signed by person filing in presence of notarial officer) State of This instrument was acknowledged before me on , County of by Date Petitioner(s) or Physician Signature of Notarial Officer / Title My Commission Expires Affix Seal, if any ORDER Request for expedited hearing is: Date Granted Judge Denied NHJB-2169-P (03/25/2013) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com