THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) STATE'S APPLICATION FOR SENTENCE REVIEW This application may be filed within 30 days after the date of sentence, but not thereafter except for good cause shown. I hereby apply for a review of the sentence imposed on (defendant's name) , on (date) NOTICE: The Sentence Review Board may make any disposition of this case that could have been made at the time of the imposition of the sentence appealed from. In addition, the Sentence Review Board has jurisdiction to review any other sentence imposed when the sentence appealed from was imposed, notwithstanding the partial execution of any such sentence. This form may be filed with the clerk of court or directly with the Secretary of the Sentence Review Division, c/o Superior Court Center, 45 Chenell Drive, Ste. 1, Concord, NH 03301 Date Prosecuting Attorney I hereby certify that a copy of this application has been forwarded to defense counsel this date. Date Prosecuting Attorney NHJB-2339-S (10/01/2006) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com