TRANSLATION OF AFFIDAVIT G.L. c. 209A or G.L. c. 258E COURT USE ONLY – DOCKET NO. TRIAL COURT OF MASSACHUSETTS __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ The affidavit was originally written in __________________________. (language) At the Courtʼs request, I have provided a written translation into English, complete and accurate to the best of my ability. ______________________________________ ______________________________________ Signature FA/HA-15 (1/12) Print Name Court Certified Interpreter Court Screened Interpreter Other _________________________ Remote Translation Via Telephone/Video American LegalNet, Inc. www.FormsWorkFlow.com