Docket No. GENERAL PROBATE PETITION Commonwealth of Massachusetts The Trial Court Probate and Family Court Division case name TO THE HONORABLE JUSTICES OF THE PROBATE AND FAMILY COURT IN AND FOR THIS COUNTY: Respectfully represents the Petitioner(s) (hereafter "Petitioner"): Name: First Name M.I Last Name (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Primary Phone #: Interest of the Petitioner in the matter (e.g., Personal Representative named in Will, surviving spouse, heir, devisee, guardian, conservator, etc): The Petitioner states the following: The Petitioner respectfully requests that this Honorable Court do the following: I certify under the penalties of perjury that the foregoing statements are true to the best of my knowledge and belief. Date: Signature of Petitioner SIGNED UNDER THE PENALTIES OF PERJURY Date: Signature of Co-Petitioner (if applicable) Information on Attorney for Petitioner Signature of Attorney (Print name) (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Primary Phone #: B.B.O. # Email: American LegalNet, Inc. www.FormsWorkFlow.com MPC 200 (3/19/12) page 1 of 1