MPC 304 (4/23/19) FLSR of3page1REQUEST FOR REASSIGNMENT Pursuant to Standing Order 3-17 Commonwealth of Massachusetts The Trial Court Probate and Family Court Docket No(s). Case Name(s):Name of assigned judge:Form Use: This form shall be used to request reassignment of an applicable case to the Fiduciary Litigation Session pursuant to Standing Order 3-17.This form must be filed in the division where the matter is pending and a copy sent contemporaneously to: (1) The Administrative Office of the Probate and Family Court, Three Center Plaza, 2nd Floor, Boston, MA 02108; and (2) to all attorneys and self-represented parties in the matter. All mailings should be designated, "Attn: FLS". IMPORTANT NOTICE: To contest reassignment to the Fiduciary Litigation Session, a written response must be filed within ten (10) calendar days of the date of service of the Request for Reassignment in the division where the matter is pending and a copy sent contemporaneously to : (1) The Administrative Office of the Probate and Family Court, Three Center Plaza, 2nd Floor, Boston, MA 02108; and (2) to all attorneys and self-represented parties in the matter. All mailings should be designated, "Attn: FLS".Name of Plaintiff/Petitioner First Name M.I. Last Name (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip)Primary Phone #: 1. e-mail: Request by assigned judgeAttorney Information, if any First Name M.I. Last Name (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip)Primary Phone #: BBO # e-mail:Other Party(ies)/Interested Person(s): First Name M.I. Last Name (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip)Primary Phone #: 2. e-mail:If necessary, attach a separate page and include all of the above requested informationAttorney Information, if any First Name M.I. Last Name (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip)Primary Phone #: BBO # e-mail: American LegalNet, Inc. www.FormsWorkFlow.com MPC 304 (4/23/19) FLSR of3page23.If applicable, list any other Probate and Family Court case related to this matter involving the same parties in the samecounty. Briefly describe the nature of the case, case name and docket number. Indicate if you request reassignment ofthis case to the FLS. NOTE: If a related case is located in another county of the Probate and Family Court, a separateRequest for Reassignment must be filed in the division where the matter is pending. Nature of the Case Division Case Name Docket # Indicate if: You request reassignmentof this case to the FLS. You request reassignmentof this case to the FLS.4.If applicable, list any other court case related to this matter involving the same parties. Briefly describe the nature of thecase, name of court and location, case name and docket number. Indicate if you intend to request an interdepartmentalassignment of this case pursuant to Trial Court Rule XII. NOTE: Cases located in another Department of the Trial Courtmay NOT be reassigned to the FLS using a Request for Reassignment. Instead, the procedure set forth in Trial Court RuleXII must be followed. The Rule may be found at www.mass.gov/trial-court-rules/trial-court-rule-xii-interdepartmental- judicial-assignments **** Any case requiring or requesting a jury trial will not be assigned to the FLS**** Nature of the Case Court/Location Case Name Docket # Indicate if: You intend to request aninterdepartmental assignment Pursuant to Trial Court Rule XII You intend to request aninterdepartmental assignment Pursuant to Trial Court Rule XII5.Do you know of any reason why a judge of the Fiduciary Litigation Session would be disqualified from this case? No Yes. If yes, explain why.6.Have the parties attempted or utilized any type of alternative dispute resolution services with a neutral third party? No YesIf yes, indicate the type of alternative dispute resolution attempted, date(s) of participation, and the result. Unknown7.Please state the nature of this case. Your request for reassignment may be determined without a hearing, or a hearingmay be scheduled for purposes of deciding whether reassignment to the Fiduciary Litigation Session is appropriate. Pleasedescribe the complexities in this case to assist in determining eligibility. If necessary, attach one additional page only.DO NOT attach any other document to this Request for Reassignment. If you want specific pleadings or documents considered in the review, refer to them by name, date of submission to the current division/court, and docket number.Parties are PROHIBITED from submitting with this Request for Reassignment any new evidence, motions, or other pleadings that have not been previously filed with the current division/court.Parties MUST limit the scope of this Request for Reassignment to only information necessary for a determination of whether reassignment to the Fiduciary Litigation Session is warranted. American LegalNet, Inc. www.FormsWorkFlow.com MPC 304 (4/23/19) FLSR of3page38.Certification: Hand-delivery OR US Mail ORI certify that on this date, I sent a copy of this document and any attachments to:(1) The Administrative Office of the Probate and Family Court, Three Center Plaza, 2nd Floor, Boston, MA 02108; (2) the division where the matter is pending; and (3) to all attorneys and self-represented parties in the matter by: E-mail Date Signature of Attorney or Self-represented Party ASSENTED TO BY: Signature of Attorney or Self-represented Party Date Approved (Docket code: FLSRA) Date Assigned Judge (Court Use Only) Denied (Docket code: FLSRD)FOR REASSIGNMENT OUT BY THE ASSIGNED JUDGE American LegalNet, Inc. www.FormsWorkFlow.com