THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) Conservatorship of PETITION FOR CONSERVATOR 1. Petitioner name Address 2. Attorney for petitioner Address 3. Proposed conservator name Relationship to petitioner Address 4. The value of the estate of the petitioner consists, as nearly as can be ascertained, of: Real Estate ......................................................................... $ Personal Estate .................................................................. Total amount of Estate ....................................................... $ $ Date of Birth Telephone Telephone Telephone The petitioner represents that by reason of mental or other physical disabilities, he or she is unfit for the management of his or her property and financial affairs. Therefore, the petitioner asks that the above proposed conservator be named to manage his or her property and financial affairs. Date Petitioner's Signature ORDER Petition for Conservator is granted; letters of appointment to be issued. Date Signature of Judge Printed Name of Judge NHJB-2161-P (01/02/2014) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com