THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) APPEARANCE/WITHDRAWAL APPEARANCE Type of appearance (Select One) Appearance Limited Appearance (Civil cases only) If limited appearance, scope of representation: Select One: As Counsel for: (Name) (Address) (Telephone Number) (Name) (Address) (Telephone Number) (Name) (Address) (Telephone Number) I will represent myself (self-represented) WITHDRAWAL As Counsel for Type of Representation: (Select one) Appearance: Notice of withdrawal was sent to my client(s) on: at the following address: A motion to withdraw is being filed. Limited Appearance: (Select one) I am withdrawing my limited appearance as I have completed the terms of the limited representation. The terms of limited representation have not been completed. A motion to withdraw is being filed. NHJB-2318-Se (07/01/2018) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case Name: Case Number: APPEARANCE/WITHDRAWAL 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-2318-Se (07/01/2018) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com