PETITION FOR FORMAL APPOINTMENT OF SUCCESSOR PERSONAL REPRESENTATIVE G.L. c. 190B, § 3-613 Estate of: First Name Middle Name Docket No. Commonwealth of Massachusetts The Trial Court Probate and Family Court Division Last Name Date of Death: Petitioner(s) (hereafter "Petitioner"), an interested person, makes the following statements: 1. Information about the Petitioner: 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 #: Interest of the Petitioner (e.g., Personal Representative named in Will, surviving spouse, heir, devisee, etc.-See G.L. c. 190B § 1-201(24)): 2. Administration is unsupervised supervised. 3. The previously appointed Personal Representative Name: First Name M.I. Last Name (Address) (Apt, Unit, No. etc.) (date) (City/Town) (State) (Zip) was appointed on has tendered a resignation which died on (date) and accompanies this Petition is in the possession of the Court. (death certificate attached). is now under a guardianship or conservatorship (letters attached). has been removed by Decree and Order of the Court issued on or such matter is pending. other: (date) MPC 270 (10/23/12) American LegalNet, Inc. www.FormsWorkFlow.com page 1 of 4 4. The Petitioner requests the following qualified person, who is 18 years of age or older, be appointed: Self: Other: First Name (Apt, Unit, No. etc.) (Address) (Apt, Unit, No. etc.) M.I. Last Name (State) (State) (Zip) (Zip) (Address) (City/Town) (City/Town) Mailing Address, if different: Primary Phone #: 5. OR The nominee has priority for appointment: by statute (G.L. c. 190B, § 3-203). for the following reasons: The nominee does not have priority for appointment. Persons with prior or equal rights to appointment are as follows: First Name M.I. No one. The following: Last Name Any required renouncements or nominations accompany this Petition. 6. The Petitioner hereby adopts the statements in the Petition that led to the appointment of the person being succeeded, except for the following changes or corrections: 7. OR A bond with sureties with the penal sum amount of $ has been or will be filed. A bond without sureties has been or will be filed and is permissible because: The Will waives sureties on the bond and no interested person has demanded that a bond with sureties be filed. All devisees (if a Will is filed) or heirs (if no Will is filed) have waived sureties in writing and the waivers are filed with this Petition or are in the possession of the Court. Other (include statutory reference): . MPC 270 (10/23/12) American LegalNet, Inc. www.FormsWorkFlow.com page 2 of 4 8. The Petitioner requests: Unsupervised administration There is no Will. The Will does not direct supervised administration. The Will directs supervised administration, but circumstances have changed since the execution of the Will and there is no necessity for supervised administration because: OR Supervised administration The Will directs supervised administration. The Will directs unsupervised administration, but it is necessary for protection of persons interested in the estate because: No Will directs supervised administration but it is necessary under the circumstances, specifically: Petitioner requests that the Court: formally appoint the nominee as Successor Personal Representative in administration to serve: without sureties on the bond. with sureties on the bond with the penal sum amount of $ and that Letters be issued. Petitioner also requests: . unsupervised supervised MPC 270 (10/23/12) American LegalNet, Inc. www.FormsWorkFlow.com page 3 of 4 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 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: MPC 270 (10/23/12) American LegalNet, Inc. www.FormsWorkFlow.com page 4 of 4