THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) NEW CASE PARTICIPANT INFORMATION Filer name: Mailing address: Street City State Zip code Telephone: E-mail: New participant name: Role in case (party type): Mailing address: Street City State Zip code Telephone: E-mail: For non e-filed cases: I state that on this date I am mailing by U.S. mail, or Email (only when there is a prior agreement of the parties to use this method), or hand delivering a copy of this document to: Other party Other party222s attorney OR For e-filed cases: I state that on this date I am sending a copy of this document as required by the rules of the court. I am electronically sending this document through the court222s electronic filing system to all attorneys and to all other parties who have entered electronic service contacts (email addresses) in this case. I am mailing or hand-delivering copies to all other interested parties. Name of Filer Signature of Filer Date Law Firm, if applicable Bar ID # of attorney Telephone Address E-mail City State Zip code NHJB-4012-Se (07/01/2018) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com