Representation Of Insolvency Form. This is a Massachusetts form and can be use in Probate And Family Court Statewide.
Tags: Representation Of Insolvency, MPC 260, Massachusetts Statewide, Probate And Family Court
Docket No. REPRESENTATION OF INSOLVENCY PURSUANT TO G.L. c. 190B, § 3-807 Commonwealth of Massachusetts The Trial Court Probate and Family Court Division Estate of: First Name Middle Name Last Name Date of Death: 1. The Personal Representative(s): Name: First Name M.I. Last Name pursuant to G.L. c. 190B, § 3-807(b), represents to the Court that the debts claimed as owed by the Decedent at the time of death, according to the list appended, amount to: Disputed by Amount of Personal Debt Representative The costs and expenses of administration, including future probable charges: Yes No The reasonable funeral expenses: Yes No The debts and taxes with preference under federal law: Yes No The reasonable and necessary medical and hospital expenses of the last illness of the Decedent, including compensation of persons attending the Decedent: Yes No The debts and taxes with preference under other laws of the commonwealth: Yes No The debts due the division of medical assistance: Yes No All other claims: Yes No Total: 2. Please explain the reason for any disputed debts listed above. 3. The estate of the Decedent known to be chargeable with the payment is as follows: Amount Real Estate not exceeding in value: Personal Estate not exceeding in value: Other estate assets outside the Commonwealth: Balance: 4. The family exemptions and allowances are: MPC 260 (3/19/12) page 1 of American LegalNet, Inc. www.FormsWorkFlow.com 2 5. The Personal Representative believes that said estate will probably be insolvent, and certifies under the penalties of perjury that the above is a correct representation of the probable condition of said estate, according to the best knowledge and belief of the Personal Representative. 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 Personal Representative Date: Signature of Co-Personal Representative (if applicable) Information on Attorney for Personal Representative Signature of Attorney (Print name) (Address) (City/Town) (Apt, Unit, No. etc.) (State) (Zip) Primary Phone #: B.B.O. # Email: 2 2