PETITION FOR SUPERVISED ADMINISTRATION G.L. c. 190B, � 3-502 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. Testacy of the Decedent and priority and qualifications of: Name: First Name Middle Name Last Name as Personal Representative(s) have been adjudicated in formal proceedings on (date) . 3. The Decedent left a Will that directs supervised administration. left a Will that directs unsupervised administration; died intestate; AND supervised administration is necessary because: OR 4. The Petitioner requests that the Court order supervised administration and: that the Personal Representative be restrained from exercising the following powers and/or that the Court make the following additional Orders: MPC 280 (3/19/12) page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 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 280 (3/19/12) page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com