Trial Court of Massachusetts Land Court Department 3 Pemberton Square, 5th floor Boston, MA 02108(617) 788-7470 NOTICE OF VOLUNTARY WITHDRAWAL OF LAND from the Registration System (G.L. c. 185, 247 52) CASE NUMBER COURT USE ONLYLCSBQ-VWD-NOT (11-2018)www.mass.gov/courts/landcourt Printed: 11/21/2018 5:29:03 PM Page 1 of 1 The owners of the fee simple estate in all of a parcel of land that has been registered under G. L. Chapter 185 withdraw the land from the provisions of 247 52 of Chapter 185. The land withdrawn is described in Certificate of Title No. in Book , at Page issued from the Registry District ofCounty, shown on Land Court Plan No. as follows: all of the land described in the certificate of title. part of the land described in the certificate of title, namely: The description of the land in the form contained in the certificate of title is attached hereto as Exhibit A.The street address (if any) of the land is: DATE SIGNED: SIGNATURE OF OWNERX PRINT NAME (FIRST, MIDDLE, LAST) STREET ADDRESS CITY/TOWN STATE ZIP CODE SIGNATURE OF OWNERX PRINT NAME (FIRST, MIDDLE, LAST) STREET ADDRESS CITY/TOWN STATE ZIP CODECOMMONWEALTH OF MASSACHUSETTSSS: Dated: Then personally appeared the above-named , and acknowledged the foregoing instrument to be their free act and deed, before meX SIGNATURE OF NOTARY PUBLICMy Commission Expires: LAND COURT ENDORSEMENTPursuant to G. L. c. 185, 247 52, the Court approves the Voluntary Withdrawal from the registration system of the land described above, subject to all registered rights outstanding as of this date. DATEDX JUSTICE American LegalNet, Inc. www.FormsWorkFlow.com