COMMONWEALTH OF MASSACHUSETTS LAND COURT DEPARTMENT OF THE TRIAL COURT

PETITION FOR APPROVAL OF A PLAN
Case No. _________________________________ Upon the petition of _______________________________________________________ alleging that: 1. He/She is the registered owner in Certificate of Title No. _________________ issued by the _______________________________________________________________________ .

2. Petitioner has filed with The Engineering Department of The Land Court Plan No. ______________ .

3. Said plan delineates_____________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

Petitioner prays that Plan No. __________________________ be approved. The forgoing statement is made under the pains and penalties of perjury. By: Name: Address: FROM THE OFFICE OF: ____________________________________ ____________________________________ ____________________________________ ____________________________________
c:\w pdocs\plan.approval.w pd

_____________________________ _____________________________ _____________________________ _____________________________

$50.00 Filing Fee