THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) MOTION FOR PERIODIC PAYMENTS (pursuant to RSA 524:6-a) Judgment not having been satisfied in full, the Plaintiff in the above-entitled matter requests the Court issue an Order of Notice/Summons requiring the Defendant to appear in court so that an order for periodic payments may be considered. Total Amount of Judgment Total Paid to Date Balance Due $ $ $ I request that service be made by certified mail, restricted delivery, return receipt requested. I request in hand service by the Sheriff. I understand that I am responsible for this cost. ENCLOSED IS MY CHECK OR MONEY ORDER IN THE AMOUNT OF $25.00 MADE PAYABLE TO THE . I certify that on this date I provided a copy of this document to Defendant/Defendant Attorney by: Hand-delivery OR US Mail OR Email (E-mail only by prior agreement of the parties based on Circuit Court or Superior Court Administrative Order) Date Plaintiff's Signature Defendant's Name and Address Plaintiff's Name and Address NHJB-2364-DPS (11/22/2013) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com