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Representation Of Insolvency Form. This is a Massachusetts form and can be use in Probate And Family Court Statewide.
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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)
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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:
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