Free Appointment of Agent (for Domestic Relations Cases) - Massachusetts

APPOINTMENT OF AGENT
Probate & Family Court Division Docket No:

I hereby appoint authorized to receive service of legal process in matters filed against me in

as my agent. My agent is County

Probate and Family Court during any period that my address is impounded. My agent may also receive notice of any pleadings and motions filed in connection with matters pending or hereafter filed in the County Probate Court during any period that my address is impoounded and I am unrepresented by counsel.

(Signature)

(Print Name)

ACCEPTANCE OF APPOINTMENT OF AGENT
I hereby accept the above appointment. Date
(Signature of Agent)

(Print Name)

(Street Address)

(City or Town)

(State)

(Zip Code)

CERTIFICATE OF SERVICE
I hereby certify that I have served a copy of this appointment of agent:

(Name of party and address or name and address of attorney of record including, street address/city or town/zip code)

by - delivery in hand on

- mailing (postage paid) on

(Date of Mailing)

(Signature) c.g.f.