Free Bristol County - Massachusetts


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

Administration De Bonis Non - With - Without - Sureties
Name of Decedent Domicile at Death
(street and no.) (county) (city or town)

Date of Death
(zip)

Name and address of petitioner Status That was appointed by this Court,

administrator/administratrix of the estate of said decedent and has died -resigned -was removed-without having fully administered said estate, that there are goods and estate of the said decedent to the amount of twenty dollars remaining to be administered:

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 . ail to the Division of Medical Assistance, P.O. Box 15205, m Worcester, Massachusetts 01615-9906. Your petitioner prays that he/she or some other suitable person of
(street and no.) (city or town)

(county)

(zip)

be appointed administrator/administratrix of the estate, not already administered, of said estate- with -without -sureties on his/her bond and certifies under the penalties of perjury that the foregoing statements herein contained are true to the best of his/her knowledge and belief. Date The undersigned hereby assent to the foregoing petition. Signature

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 of administrator/administratrix of said estate, not already administered, first giving bond with for the due performance of said trust. Date
CJ-P 5 (I I /01)

be appointed sureties,

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

For Petitioner:

Docket No.

Administration De Bonis Non
Tel. No. ( B.B.O. #

With The Will Annexed
) With/Without Sureties 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 193, Section 9.