Commonwealth of Massachusetts The Trial Court Probate and Family Court Department Middlesex Division Docket No: Affidavit of Filing of Certified Copy of Child Custody Judgment Pursuant to M.G.L. C. 209B I hereby certify under the penalties of perjury that the attached is a certified copy of the child custody judgment adjudicating the custody of issued by a court of competent jurisdiction in the State of I further certify that this judgment is currently in full force and effect. (Signature) (Print Name) (Address) NOTARIZATION SS Date: Then personally appeared ________________________________________________________ to me known and made oath that the information contained in the foregoing statement is true to the best of his/her knowledge and belief. Before me, Notary Public/Justice of the Peace My commission expires: Certificate of Filing of Certified Copy of Child Custody Judgment Pursuant to M.G.L. c. 209B I hereby acknowledge that a certified copy of the child custody judgment adjudicating the custody of _____________________________________________________issued by the __________________________Court, of the State of __________________________ has been filed at the Registry of Probate for the County of Plymouth, this _________ day of ______________________________, 20______. Register of Probate NOTE This Affidavit must be accompanied by: 1). A certified copy of the Judgment to be registered; 2). Affidavit Disclosing Care and Custody American LegalNet, Inc. www.USCourtForms.com mcpfc - c.g.f.