RECORD CHECK: FORM CP2 FILL IN THE BLANKS ON THE FORM. PLEASE TYPE OR PRINT. COURT/DOCKET NOS. OR AGENCY Suffolk Probate & Family Court M DATE NAME DATE OF BIRTH (MO / DAY / YR) ADDRESS HEIGHT SEX PLACE OF BIRTH WEIGHT RACE MOTHER'S NAME/ MAIDEN NAME FATHER'S NAME If your name was different when you were born, write it below. SOCIAL SECURITY NO. APPLICANTS SIGNATURE AND DATE REASON FOR INQUIRY Name Change Official use only below Record Comp by Phone Photocopy Sealed No No Additional Record REMARKS CP2-REQUEST FOR INFORMATION INITIALS DATE PROCESSED FORM CP 2M-120M.12183-176286 CERTIFICATE ORDER FORM Complete the form and mail or return in person with $20 for each certificate to: Suffolk County Probate and Family Court Registry 24 New Chardon Street, 3rd Floor Boston, MA 02114 . We accept personal checks, money orders or cash. (We do not advise mailing cash.) REQUEST FOR CERTIFICATES Date: Docket Number: Your name (or name on case if different): Number of certificates (at $20 each): Please mail certificate(s) to: Name: Address: City/Town State Zip Note: All copies must be paid for in advance American LegalNet, Inc. www.FormsWorkflow.com