PETITION FOR ALLOWANCE OF ACCOUNT Docket No. Commonwealth of Massachusetts The Trial Court Probate and Family Court Estate of: Conservatorship of: Trust: Other: Division I. GENERAL INFORMATION The Petitioner(s) (hereafter "Petitioner") makes the following statements: 1. Information about the Petitioner: Name: First Name Middle Name Last Name (Address) (Apt, Unit, No. etc.) (Address) (Apt, Unit, No. etc.) (City/Town) (City/Town) (State) (State) (Zip) (Zip) Mailing Address, if different: Primary Phone #: Interest of the Petitioner: Personal Representative Date of appointment: Other: (relationship) Special Personal Representative Conservator Trustee 2. Information on the Trust, if applicable: Identify the Trust and Settlor (e.g. ABC Trust, Trust under written instrument by Jane Smith, under the will of Jane Smith dated 1/1/12, etc.): Date of Trust: (date) Dates of Amendments, if any: A copy of the trust and any amendments are attached or are on file with the court. Venue for this proceeding is proper in this court because: 3. The (specify whether 1st, 2nd, etc.) account is on file with the court or accompanies this Petition. II. PERSONS INTERESTED IN THE ESTATE 4. The names and addresses of all interested persons and their interest are as follows: NAME ADDRESS (omit if since deceased) INTEREST (e.g. heir, protected person, beneficiary, etc.) American LegalNet, Inc. www.FormsWorkFlow.com MPC 857 (3/1/17) page 1 of 4 ALL PETITIONERS MUST COMPLETE 5 AND 6, IF APPLICABLE 5. NONE of the interested persons are under a legal disability except for: REPRESENTED BY LEGAL DISABILITY * (Motion and affidavit required to waive appointment of Guardian ad litem (GAL)). NAME NAME/ADDRESS OF REPRESENTATIVE (Provide docket number or proof of appointment for any court appointed fiduciary.) NAME REPRESENTED BY LEGAL DISABILITY * (Motion and affidavit required to waive appointment of Guardian ad litem (GAL)). NAME/ADDRESS OF REPRESENTATIVE (Provide docket number or proof of appointment for any court appointed fiduciary.) Unborn/ Unascertained Unborn Unascertained Unrepresented or only represented by the accountant (appointment of GAL requested) Other*: (list relationship and rule/statutory authority) Minor List age: Incapacitated Person (adjudicated or alleged) Unrepresented or only represented by the accountant (appointment of GAL requested) Other*: Protected Person (adjudicated or alleged) (list relationship and rule/statutory authority) NAME REPRESENTED BY LEGAL DISABILITY * (Motion and affidavit required to waive appointment of Guardian ad litem (GAL)). NAME/ADDRESS OF REPRESENTATIVE (Provide docket number or proof of appointment for any court appointed fiduciary.) Unborn/ Unascertained Unborn Unascertained Unrepresented or only represented by the accountant (appointment of GAL requested) Other*: (list relationship and rule/statutory authority) MPC 857 (3/1/17) page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com NAME REPRESENTED BY LEGAL DISABILITY * (Motion and affidavit required to waive appointment of Guardian ad litem (GAL)). NAME/ADDRESS OF REPRESENTATIVE (Provide docket number or proof of appointment for any court appointed fiduciary.) Minor List age: Incapacitated Person (adjudicated or alleged) Unrepresented or only represented by the accountant (appointment of GAL requested) Other*: Protected Person (adjudicated or alleged) (list relationship and rule/statutory authority) 6. NONE of the interested persons are deceased at the time of this filing except for: NAME OF SINCE DECEASED INTERESTED PERSON NAME/ADDRESS OF REPRESENTATIVE DATE OF DEATH REPRESENTED BY Unrepresented (NOTE: Publication and Guardian ad litem may be required.) Personal Representative Other: (Provide docket number or proof of appointment for any court appointed fiduciary.) (list relationship and rule/statutory authority) MPC 857 (3/1/17) page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com III. RELIEF REQUESTED Wherefore the Petitioner requests that the court: Approve The Petitioner also requests: account as filed, including the distribution as stated therein. 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 Petitioner Information on Attorney for Petitioner, if any 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 857 (3/1/17) page 4 of 4