THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) APPEARANCE or WITHDRAWAL Complete this form for either an appearance or a withdrawal. APPEARANCE Please enter my appearance as: Attorney for Enter name(s) of party(ies) you represent. MOTION FOR WITHDRAWAL Please withdraw my appearance as: Attorney for (attorney only) Enter name(s) of party(ies) you represent. Reason for withdrawal: Pro se (appearing for one's self) Check the capacity of pro se party or party represented by attorney: fiduciary creditor heir beneficiary/legatee other WITHDRAWAL (other than attorney) Please withdraw my appearance in my capacity as: fiduciary creditor heir beneficiary/legatee other PLEASE PRINT OR TYPE THE FOLLOWING INFORMATION. ALL NOTICES FROM THE COURT WILL BE SENT TO THE ATTORNEY OR PRO SE PARTY NAMED BELOW. Attorney or pro se name Name of law firm (if applicable) Mailing address Telephone number Email Address (optional) NH Bar ID# I certify that on this date I provided this document(s) to the parties who have filed an appearance for Hand-delivery OR US Mail OR this case or who are otherwise interested parties by: Email (E-mail only by prior agreement of the parties based on Circuit Court Administrative Order). Date Signature ORDER Motion for withdrawal granted. Motion for withdrawal denied. Date NHJB-2119-P (03/25/2013) Page 1 of 1 Judge American LegalNet, Inc. www.FormsWorkFlow.com