Free Hampshire County - Massachusetts

Hampshire Division

Commonwealth of Massachusetts The Trial Court Probate and Family Court Department

Docket No.

Affidavit of Notice to Devisees and Legatees Estate of late of
(Street and No.) (City or Town) (County) (zip)

,deceased.

In the matter of the notice to devisees and legatees required by General Laws Chapter 192, Section 12.
I

hereby, certify under the penalties of perjury that the names and addresses of all the devisees and legatees named in said will, to whom I gave notice by mail are as follows: Name Residence

Date
EXECUT /ADMINISTRAT

CJ-P 14B (4/89)

hcpfc - c.g.f.