Free - Massachusetts

Commonwealth of Massachusetts The Trial Court Probate and Family Court Department
Division Docket No.

Plaintiff/Petitioner

V.

MOTION FOR CITY/TOWN CLERK TO RELEASE A COPY OF THE CHILD'S BIRTH CERTIFICATE
Plaintiff Defendant Petitioner Respondent.

Defendant/Respondent

Now comes
(name of moving party)

who moves this Honorable Court to order the City/Town Clerk of
(City/Town of the Hospital where the child was born)

to release the birth certificate of
(child's full name, first, middle and last)

date of birth

, for the reason(s) set forth in the attached affidavit.
(Date of Birth)

Date
(Signature of attorney or plaintiff, if pro se)

(Print name)

(Street address)

The within motion is hereby

(City/Town)

(State)

(Zip)

ALLOWED

DENIED

JUSTICE OF THE PROBATE AND FAMILY COURT

Dated:

CJ-D 400 Release of Child's Birth Certificate

C.G.F.