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

Probate of Will With/Without Sureties
Name of Decedent Domicile at Death
(street and no.) (city or town)

Date of Death
(county) (zip)

Name and address of Petitioner(s) Status Heirs at law or next of kin of deceased Including surviving spouse: Name Residence (minors and incompetents must be so designated) Relationship

That said deceased left a will-and codicil (s) -herewith presented, wherein your petitioner(s) is/are named execut had requested that your petitioner(s) be exempt from giving surety on and wherein the testat his/her/their bond(s). that a copy of this document, along with a copy of the decedent's The petitioner(s) hereby certif death certificate has been sent by certified mail to the Division of Medical Assistance, P.O. Box 15205, Worcester, Massachusetts 01615-9906. Wherefore your petitioner(s) pray(s) that said will-and codicil(s)-may be proved and allowed, and that he/she/they be appointed execut thereof, with/without surety on his/her/their bond(s) and certif under the penalties of perjury that the statements herein contained are true to the best of his/her/their knowledge and belief. Date Signature(s)

The undersigned hereby assent to the foregoing petition and to the allowance of the will without testimony.

DECREE All persons interested having been notified in accordance with the law or having assented and no objections being made thereto, it is decreed that said instrument(s) be approved and allowed as the last will and testament of said deceased, and that said petitioner(s): of of and be appointed sureties for the due performance of said trust. thereof, first giving bond with execut Date
CJ-P 2 (11 /01)

Justice of the Probate and Family Court pcpfc - c.g.f.

For Petitioner:

Docket No.

Probate of Will
With/Without Sureties Tel. No. ( B.B.O. # ) Petition - Decree

For Respondent: Filed Citation Issued Tel. No. ( B.B.O. # Publication in the ) Returnable Allowed Recorded Vol. Page ,20 ,20 ,20 ,20

Instructions
Refer to Massachusetts General Laws Chapter 192.