COMMONWEALTH OF MASSACHUSETTS __________________SS: HOUSING COURT DEPARTMENT _______________________ DIVISION / / /SP-/ / / / / / _____________________________________ Plaintiff/Landlord VS. ______________________________________ Defendant/Tenant STIPULATION FOR RENT, REPAIRS, AND REVIEW The undersigned parties hereby stipulate and agree as follows: 1. The tenant shall pay rent of $_____________on ______________________ for __________________ to __________________________and shall pay rent of $____________________ on ______________ _____________________ for ___________________________ to ____________________________all pending further agreement or further order. 2. The landlord shall make the following repairs to the premises according to the following schedule: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 3. The Housing Specialist shall view conditions at the premises on __________________________ at __________________o’clock, and shall report to the parties and to the court [orally] [in writing] on __________________________________ at ___________________o’clock. 4. The parties shall appear in court on ___________________________ at _____________________ o’clock for further review or trial on the merits of the action. American LegalNet, Inc. www.USCourtForms.com 5. The parties further agree as follows: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ONCE APPROVED BY THE JUDGE, THIS AGREEMENT BECOMES A COURT ORDER AND BOTH PARTIES ARE LEGALLY REQUIRED TO FOLLOW IT. If questions arise, please consult the Housing Specialist. I UNDERSTAND THAT I HAVE THE RIGHT TO A HEARING ON MY CASE BEFORE A JUDGE, BUT INSTEAD, I CHOOSE TO SIGN THIS AGREEMENT. __________________________________________ Signed and dated by Landlord: __________________________________________ Signed and dated by Tenant: __________________________________________ Plaintiff(s) Attorney: __________________________________________ Defendant(s) Attorney: _____________________________________ Housing Specialist: __________________________________________ Judge: Copies (given) (mailed) to parties on: __________________________________ American LegalNet, Inc. www.USCourtForms.com