Case Name:
Case Number:
MOTION:
Filing Statement:
I am filing this pleading on my own behalf. The information contained in this pleading is true to
the best of my knowledge and belief. I understand that making a false statement in this pleading may
subject me to criminal penalties.
OR
I am an attorney filing this pleading on behalf of my client or I am a person authorized by court
rules to appear on behalf of another. To the extent this pleading contains facts not apparent in the
case file, I am attaching an affidavit or statement signed under penalty of criminal prosecution
attesting to the truth of those facts.
I state that on this date I am sending a copy of this document as required by the rules of the
Circuit Court. I am electronically sending this document through the court’s 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
/s/
Signature of Filer Date
Law Firm, if applicable Bar ID # of attorney Telephone
Address E-mail
City State Zip code
NHJB-2201-DFPe* (01/01/2018) Page 2 of 2
