Free - Massachusetts

Division

Commonwealth of Massachusetts The Trial Court Probate and Family Court Department

Docket No.

Plaintiff/Petitioner

V.

MOTION TO IMPOUND ADDRESS

Defendant/Respondent

Now comes
(name of moving party)

Plaintiff

Defendant

Petitioner

Respondent.

In this action who requests this Honorable Court as follows: To impound my address for the following reason(s) as stated on the attached affidavit.

Date NOTICE OF HEARING This motion will be heard at the Probate and Family Court In
(city)

(Signature of attorney or plaintiff, if pro se)

(Print name)

(Street address)

On
(month/day/year) (City/Town) (State) (Zip)

At
(time of hearing)

Tel. No: B.B.O.

The within motion is hereby

ALLOWED

DENIED

Date

JUSTICE OF THE PROBATE AND FAMILY COURT Page 1 of 2

CJ-D 400 Motion to Impound Address

C.G.F.

Commonwealth of Massachusetts The Trial Court Probate and Family Court Department
Division

Docket No.

MOTION TO IMPOUND ADDRESS

Dated:

CERTIFICATE OF SERVICE

I hereby certify that I have delivered a copy of this motion to:

(name of party or attorney of record)

(Street address)

(City/Town)

(State)

(Zip)

By

delivery in hand
(date of delivery)

at

(time)

AM

PM

mailing (postage paid on)
(date of mailing)

(signature)

CJ-D 400 Motion to Impound Address

Page 2 of 2

C.G.F.