JV-135 (Rev. 11/05/2018) AFFIDAVIT OF NOTICE BY PUBLICATION AND/OR CERTIFIED OR REGISTRED MAIL DOCKET NUMBER Trial Court of Massachusetts Juvenile Court Department DIVISION In the Matter of: 1. Complete this section if you were ordered to give notice by publication. (You must complete Section 2 below if you were also ordered to give notice by certified or registered mail, return receipt requested.) I, , hereby certify under the pains and penalties of perjury that in accordance with the order of this Court, I caused to be published the Order of Notice in this matter: Check One: successive weeks in the , a newspaper published in , said publication(s) being made on ; on ; and on ; a clipping/clippings of said Order of Notice of publication(s) from the newspaper page(s) in which said publication(s) appeared being attached hereto and made a part of this affidavit. once once in each of (name of person who caused service by publication)(name of newspaper)(date of third publication, if applicable)(date of second publication, if applicable)(date of first publication)(mailing address of newspaper)2. Complete this section if you were ordered to give notice by certified or registered mail. (This section must be completed if (1) you were also ordered to give notice by publication or, (2) you were only ordered to give notice by certified or registered mail, return receipt requested.) I hereby certify that I provided a copy of the summons or notice and a copy of the petition as ordered to the following: I hereby certify that I was unable to provide a copy of the summons or notice and a copy of the petition as ordered for the following reason(s): Print Name: B.B.O. No.: Signature:(if applicable) Date:(address)(name)(address)(name) American LegalNet, Inc. www.FormsWorkFlow.com