Instructions
Clear Form
THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us
Court Name: Case Name: Case Number:
(if known)
Trust of
PETITION FOR SPECIAL NEEDS TRUSTEE
1. Petitioner Name Mailing Address Petitioner Name
Mailing Address
2. Attorney Name Mailing Address
Telephone
Telephone
Telephone
Bar ID#
3. List names and addresses of beneficiaries of trust. LIFETIME BENEFICIARY NAME ADDRESS DATE OF BIRTH
REMAINDERMAN NAME
ADDRESS
DATE OF BIRTH
4. The estimated value of the trust estate is: Real Estate.............................................................................. $ Personal Estate ....................................................................... $ Total amount of Estate ............................................................ $
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0.00
NHJB-2559-P (12/01/08)
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Case Name: Trust of Case Number:
PETITION FOR TRUSTEE
5. A copy of the trust has been sent to the Department of Health and Human Services. Yes No The petitioner requests that appointment be granted to of and whose date of birth is The petitioner also requests that the following impartial appraiser be appointed to take inventory and appraise the trust assets. Appraiser name Appraiser Address
I certify that a copy of this document has been provided to the parties who have filed an appearance for this case or who are otherwise interested parties. I have filed a copy of the Special Needs Trust with this petition. Occupation
Date
Petitioner Signature
Date
Petitioner Signature
ORDER
Petition is granted. Letter of trust will be issued, conditional on the filing of a fiduciary bond in the amount of $ , without sureties with personal sureties with corporate sureties, within Petition is denied. days of this order.
Date
Judge
NHJB-2559-P (12/01/08)
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