Request For Court Discharge {NHJB-2595-D}

THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) REQUEST FOR COURT DISCHARGE 1. Defendant Name Defendant Address 2. Attachment to be discharged is recorded at Book , Page County Registry of Deeds: The Defendant states the following: 3. The judgment in favor of the Plaintiff and against the Defendant has been satisfied/paid in full. Proof that the judgment has been paid in full is by one of the following documents. A copy of the document is attached. Bank check Certified check Attorney's Client Funds account check (bearing no indication of a stop payment order or return for insufficient funds) Equivalent documentary evidence (please specify): 4. The Defendant has asked the Plaintiff to discharge the attachments, but the Plaintiff has not complied and: 30 days have passed since the request was received, OR, Circumstances require an immediate discharge (please specify): The Defendant understands that it is a class B misdemeanor to ask a court to grant a discharge in accordance with RSA 503:12 based on information and statements known by the person to be false. The Defendant requests that the court, pursuant to RSA 503:12, IV (a), issue a discharge of the above referenced Small Claim Attachment. I certify that on this date I provided a copy of this document to Plaintiff/Plaintiff Attorney by: Hand-delivery OR US Mail OR E-mail (E-mail only by prior agreement of the parties based on Circuit Court Administrative Order). Date Defendant State of This instrument was acknowledged before me on My Commission Expires Affix Seal, if any NHJB-2595-D (03/25/2013) Page 1 , County of by Signature of Notarial Officer / Title American LegalNet, Inc. www.FormsWorkFlow.com