PETITION FOR INFORMAL APPOINTMENT OF SUCCESSOR PERSONAL REPRESENTATIVE G.L. c. 190B, §§ 3-301 & 3-613(a)(6) 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") 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. 3. The previously appointed Personal Representative Name: First Name M.I. Last Name (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) was appointed on (date) and has tendered a resignation which died on (date) 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. (date) 4. 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 (G.L. c. 190B, § 3-301(a)(6)): MPC 255 (10/23/12) American LegalNet, Inc. www.FormsWorkFlow.com page 1 of 3 5. The Petitioner requests the following qualified person, who has priority and is 18 years of age or older, be appointed: Self. Other: First Name M.I. Last Name (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Mailing Address, if different: (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Primary Phone #: 6. 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. 7. OR A bond without sureties has been 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): The Petitioner requests that the Court: informally appoint the nominee as Successor Personal Representative in unsupervised administration to serve: without sureties on the bond. with sureties on the bond with the penal sum amount of $ and that Letters be issued. . . A bond with sureties with the penal sum amount of $ has been filed. MPC 255 (10/23/12) American LegalNet, Inc. www.FormsWorkFlow.com page 2 of 3 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 255 (10/23/12) American LegalNet, Inc. www.FormsWorkFlow.com page 3 of 3