THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) NON - LAWYER AFFIDAVIT REQUIRED BY SUPERIOR COURT RULE 20 APP EARANCE ON BEHALF OF INDIVIDUAL I, , swear or affirm: (state your name) 1. That I have attached a true and exact copy of a duly executed power of attorney that appoints me as attorney-in-fact to appear in this particular action on behalf of (name of party). This power of attorney has not been rescinded or modified, and is in full force and effect. 2. That I have not been convicted of any felonies or misdemeanors which have not been annulled except those listed as follows: . 3. That I have not been found by a court to have violated a court order or any of the rules of professional conduct applicable to non-lawyer representation except as set forth as follows: . 4. That I have not been permitted to appear, plead, prosecute or defend any action for any party, other than myself, in any court except those listed as follows: . 5. That I acknowledge I must comply with the Rules of Professional Conduct as set forth in Professional Conduct Rule 8.5, and that I shall be subject to the jurisdiction of the Committee on Professional Conduct. NHJB-2848-Se (07/01/2018) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 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 signature to this document I acknowledge my understanding that any false statements made in this motion are punishable as perjury which may include a fine or imprisonment or both. Name of Filer Signature Date Address Telephone City State Zip code E-mail NHJB-2848-Se (07/01/2018) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com