COMMONWEALTH OF MASSACHUSETTS LAND COURT DEPARTMENT OF THE TRIAL COURT PETITION FOR APPROVAL OF A PLAN Case No. _________________________________ Upon the petition of _______________________________________________________ alleging that: 1. He/She is the registered owner in Certificate of Title No. _________________ issued by the _______________________________________________________________________ . 2. Petitioner has filed with The Engineering Department of The Land Court Plan No. ______________ . 3. Said plan delineates_____________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Petitioner prays that Plan No. __________________________ be approved. The forgoing statement is made under the pains and penalties of perjury. By: Name: Address: FROM THE OFFICE OF: ____________________________________ ____________________________________ ____________________________________ ____________________________________ _____________________________ _____________________________ _____________________________ _____________________________ $50.00 Filing Fee c:\w pdocs\plan.approval.w pd American LegalNet, Inc. www.FormsWorkflow.com