Commonwealth of Massachusetts PROBATE AND FAMILY COURT DEPARTMENT Gina L. DeRossi Register Bristol Division REQUEST FOR PRE-TRIAL ASSIGNMENT REQUEST CASE MANAGEMENT CONFERENCE Docket No. Counsel or Parties requesting a Pre-Trial are certifying, by making this request, that all appraisals of Real Estate and personal property have been completed, that discovery has been completed and pensions have been valued. Sanctions may result from a failure to comply with this requirement. Also, kindly verify if either of the parties in this action is receiving public assistance. Please assign for hearing: ______________________________________________________ Plaintiff V. ______________________________________________________ Defendant TYPE OF CASE: For ADA accommodation needs, please call (508) 672-4669 x 204 Contested as to: Merits Custody Visitation 208, § 34 Other The following papers must be on file before cases can be assigned for hearing: Summons or Return of Service Marriage Certificate Statistical Form R408 Financial Statement (Supp. Rule 401) Other Yes Yes Yes Yes No No No No Parenting Education Classes are complete and certificates are filed One of the parties requires interpreter services One of the parties is on welfare or is making application for welfare Have discovery, appraisals and valuations been completed? I hereby certify that, in my opinion, this case is ready for trial. Language Country of Origin DATE: Copy of this request has been mailed to the following named Requested by: Attorneys/Pro Se Litigants in this action. Name: Address: Street City Zip Name: Address: Street City Zip Phone: Phone: This form should not be used for mark-up of temporary orders and motions. Instead, affidavits of notice should be filed in accordance with the rules, after an available time and place for hearing has been obtained from the Register's Office. FOR REGISTER'S USE ONLY ACTION The above-entitled matter has been: assigned for Pre-Trial Conference at at Date of notice: Returned without action. Data incomplete. See above. bc-405B R6/2003 ­ Register of Probate on . 20 Clerk's Initials American LegalNet, Inc. www.FormsWorkFlow.com