Attorneys Statement {NHJB-2036-DFSUP}

THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) EMPLOYMENT SECURITY WAGE GARNISHMENT MOTION FOR PERIODIC PAYMENTS (pursuant to RSA 282-A:152-a) Upon the Defendant filing for suspension of the notice of garnishment, the Department of Employment Security requests the Court to issue Orders of Notice requiring the Defendant to appear in court so that an order for periodic payments may be considered. Total Amount of Overpayment $ Total Paid to Date Balance Due CHOOSE ONE: Request that service be made by certified mail, restricted delivery, return receipt requested. Request personal service by a law enforcement officer. $ $ I certify that I have mailed a copy of this motion to the Defendant at address below. Date Department of Employment Security Authorized Signature Def Name Street address City/state/zip Plaintiff Name Street address City/state/zip NHJB-2767-D (08/10/2012) American LegalNet, Inc. www.FormsWorkFlow.com