Free Bristol County - Massachusetts

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

Probate Of Will - Administration With The Will Annexed 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 is named executor/executrix but has - declined to serve - died - become incapacitated. The petitioner(s) hereby certif that a copy of this document, along with a copy of the decedent's 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 or some other suitable person of
(street and no.) (city or town) (county) (zip)

be appointed administrator/administratrix with the will annexed, - with - without - sureties on his/her bond, 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 of in the County of be appointed administrat with the will annexed of said estate first giving bond, with sureties, for the due performance of said trust. Date
CJ-P 3 (11 /01)

Justice of the Probate and Family Court

bcpfc - c.g.f.

For Petitioner:

Docket No.

Tel. No. ( B.B.O. #

)

Probate Of Will Administration With The Will Annexed
With/Without Sureties Petition - Decree Filed Citation Issued Returnable ,20 ,20 ,20 ,20 Page

For Respondent:

Tel. No. ( B.B.O. #

)

Allowed Recorded Vol.

Publication in the

Instructions
Refer to Massachusetts General Laws Chapter 193, Section 7.