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Docket No. MUPC SUPPLEMENTAL NOTICE Commonwealth of Massachusetts The Trial Court Probate and Family Court Estate of: First Name Middle Name Last Name Division Also Known As: Date of Death: To all persons who may have an interest in the above-captioned estate, the Division of Medical Assistance and, if interested, to the Office of the Attorney General and the United States Department of Veterans Affairs; Notice is being sent to you as you may have a legal interest in this case, in order to inform you of your rights. Under the new Massachusetts Uniform Probate Code Inventory and Accounts are not required to be filed with the Court, but interested parties are entitled to notice regarding the administration from the Personal Representative and can Petition the Court in any matter relating to the estate, including distribution of assets and expenses of administration. Interested parties are entitled to Petition the Court to institute formal proceedings and to obtain orders terminating or restricting the powers of the appointed Personal Representative. Petitioner requests to be permitted to file a MUPC Bond. PUBLISH ONLY THE NOTICE ABOVE (if necessary) NOTE: This is a transition notice only to be used with citations which are issued prior to March 31, 2012. MPC 591 (12/29/11) American LegalNet, Inc. www.FormsWorkFlow.com page 1 of 2 Docket No. MUPC SUPPLEMENTAL NOTICE RETURN OF SERVICE I, specified below: To: at: (address) (name) Commonwealth of Massachusetts The Trial Court Probate and Family Court , hereby certify that notice was given to each interested person as by certified/registered mail on: hand delivery (date) To: at: (address) by certified/registered mail on: hand delivery (date) To: at: (address) by certified/registered mail on: hand delivery (date) To: at: (address) by certified/registered mail on: hand delivery (date) By publishing once in (name of newspaper) on: (date) which was at least seven (7) days before the return date. The following interested persons have waived notice and the waivers are filed with this Notice or are in the possession of the Court: Service was not made. SIGNED UNDER THE PENALTIES OF PERJURY. I certify under the penalties of perjury that the foregoing statements are true to the best of my knowledge and belief. Date Signature of Attorney for the Petitioner or Petitioner if Pro Se Signature of Attorney for the Petitioner or Petitioner if Pro Se (Address) (City/Town) (State) (Apt, Unit, No. etc.) (Zip) (Address) (City/Town) (State) (Apt, Unit, No. etc.) (Zip) Primary Phone #: B.B.O. #: Primary Phone #: B.B.O. # MPC 591 (12/29/11) American LegalNet, Inc. www.FormsWorkFlow.com page 2 of 2