STATEMENT OF CONFIRMATION OF APPOINTMENT OF A TESTAMENTARY TRUSTEE Estate of: First Name Middle Name Docket No. Commonwealth of Massachusetts The Trial Court Probate and Family Court Division Last Name Date of Death: Original Trustee Successor Trustee The Trustee of a testamentary trust makes the following statements: 1. Information about the Trustee: Name: First Name M.I. 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 #: 2. The Decedent's will was allowed on: (date) . 3. The will gave certain estate in trust for the use and benefit of: (name(s)) and appointed the above-named person to act as Trustee or Successor Trustee. resigned died been removed or 4. If this confirmation is for a successor Trustee, the prior Trustee has since become incapacitated. The will appointed the Successor Trustee or if not, the Successor Trustee is a person appointed by unanimous agreement of the qualified beneficiaries. FORM ALERT: Please attach a copy of the resignation if the prior trustee has resigned or a suggestion of death or death certificate if deceased. If the qualified beneficiaries are appointing the Successor Trustee by unanimous agreement, you must submit a joint affidavit. The affidavit must be signed by all qualified beneficiaries identifying their status as such, indicating whether any are under a legal disability, and that all agree to appoint the named person as Successor Trustee. 5. Select one of the following: A bond without with sureties in the penal sum amount of $ accompanies this Statement or is in the possession of the court. A bond without sureties is permissible because: The terms of the trust waive sureties on the bond. Other (include statutory reference): American LegalNet, Inc. www.FormsWorkFlow.com MPC 275 (3/1/17) page 1 of 2 6. The Trustee is willing to accept said trust and furnishes bond according to law for the faithful discharge thereof. 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 Trustee Information on Attorney for Trustee, if any Signature of Attorney (Print name) (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Primary Phone #: B.B.O. # Email: AN ATTESTED COPY SHALL NOT ISSUE UNTIL APPROVAL OF THE BOND FOR COURT USE ONLY As Register of Probate having the care and custody of the records pertaining to this court, I certify that the preceding document is a true, exact, complete, and unaltered copy of the Statement of Confirmation of a Testamentary Trustee filed with this court. Date REGISTER OF THE PROBATE & FAMILY COURT American LegalNet, Inc. www.FormsWorkFlow.com MPC 275 (3/1/17) page 2 of 2