STATEMENT OF RESIGNATION OF A PERSONAL REPRESENTATIVE G.L. c. 190B § 3-610 Estate of: First Name Middle Name Docket No. Commonwealth of Massachusetts The Trial Court Probate and Family Court Division Last Name Date of Death I, the Personal Representative of the above estate, do hereby resign as of (date) . Fifteen (15) days written notice has been given to the persons known to me to be interested in this estate. I realize this resignation is effective only upon the appointment and qualification of a successor personal representative and the delivery of the assets to that person. I further understand that the resignation of appointment does not discharge a personal representative from liability for transactions or omissions occurring before resignation is effective, nor does it relieve the personal representative of the duty to preserve assets subject to his control, to account, and to deliver the assets. 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 (Print name) (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Primary Phone #: Information on Attorney for Personal Representative Signature of Attorney (Print name) (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Primary Phone #: B.B.O. # Email: FOR COURT USE ONLY The above resignation is hereby effective on (date) . Date Justice Magistrate American LegalNet, Inc. www.FormsWorkFlow.com MPC 264 (10/23/12) RESGN