Docket No. ORDER APPOINTING SPECIAL PERSONAL REPRESENTATIVE Estate of: First Name Middle Name Last Name Commonwealth of Massachusetts The Trial Court Probate and Family Court Division Also Known As: Date of Death: After hearing on the Petition for Appointment of a Special Personal Representative, all persons interested, having assented or having been notified in accordance with the law; OR no notice having been given and it appearing to the Court that an emergency exists; The Court finds that appointment is necessary to preserve the estate or to secure its proper administration including its administration in circumstances where a general Personal Representative cannot or should not act. 1. The Court appoints the following person(s) as Special Personal Representative(s) (hereafter "Special Personal Representative"): Name: First Name (Apt, Unit, No. etc.) M.I. (City/Town) Last Name (Address) (State) (Zip) Primary Phone #: Name: First Name (Apt, Unit, No. etc.) M.I. (City/Town) Last Name (Address) (State) (Zip) Primary Phone #: 2. The Special Personal Representative shall serve with authority limited to conducting a search of any safe deposit box of the decedent for his or her last Will and Testament in the presence of a bank officer or other disinterested person. authority to act pursuant to G.L. c. 190B, §§ 3-614, 3-617, 3-715 et seq. and 3-715(b), as follows: The Special Personal Representative has the duty to collect and manage the assets of the estate, to preserve them, to account for them and to deliver them to the Personal Representative upon qualification by the Court. The Special Personal Representative has the power of a Personal Representative necessary to perform these duties. MPC 650 (3/19/12) ORSPR page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Docket No. Estate of: First Name Middle Name Last Name 3. The Special Personal Representative shall serve: Without a surety on the bond because: Language in the Will waives the requirement of a surety bond. All of the heirs or all of the devisees have filed a written waiver of sureties on the bond. The Personal Representative is a bank or trust company. The Court concludes that sureties are not in the best interest of the estate. with personal corporate sureties on the bond. A Demand for Sureties (MPC 360) has been filed. NO LETTERS OF SPECIAL PERSONAL REPRESENTATIVE SHALL ISSUE UNTIL THE BOND IS FILED AND APPROVED 4. Additional powers granted, if any, as follows: 5. Additional restrictions, if any, as follows: 6. The Special Personal Representative shall file an Account, for approval, with the Court on or by (date) 7. The appointment shall expire on: (date) . appointed 8. The authority of First Name Middle Name Last Name as Personal Representative on appointment. Date (date) is hereby suspended during the pendency of this Justice of the Probate and Family Court MPC 650 (3/19/12) ORSPR page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com