THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) MILI TARY SERVICE STATEMENT I (WE) [enter name(s) of plaintiff(s)] of [enter address] state the following facts showing that, to the best of my (our) knowledge and belief: The defendant(s) is (are) not in the military or other service of the United States included in the provisions of the Servicemembers Civil Relief Act (SCRA) and has (have) not been called by the governor to active duty for a period of 30 days or more as a member of the state guard or national guard or as a member of the militia within the meaning of RSA 110-C:2. (Please state supporting facts, i.e., where respondent(s)/defendant(s) is (are) living, employed, or approximate age sufficient to show not in military service). OR The defendant(s) is (are) in the military or other service of the United States included in the provisions of the Servicemembers Civil Relief Act (SCRA) or has (have) been called by the governor to active duty for a period of 30 days or more as member of the state guard or national guard or as a member of the militia within the meaning of RSA 110-C:2. (Please state the name of the branch service and the defendant222s address). Filing Party222s Verification: I verify the truth and accuracy of all facts alleged within this document to the best of my belief and further verify that all facts contained in this document are alleged in good faith. By affixing my electronic signature to this document I acknowledge my understanding that any false statements made in this document are punishable as perjury which may include a fine or imprisonment or both. Name of Filer Signature of Filer Date Law Firm Bar ID # of attorney Telephone Address E-mail City State Zip code NHJB-4015-Se (07/01/2018) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com