Free - Massachusetts

Plymouth

Division

Commonwealth of Massachusetts The Trial Court Probate and Family Court Department AFFIDAVIT

Docket No.

In the Estate of I / We hereby certify that the executor who is named in the will, the temporary executor whose appointment is sought, the person(s) who has / have requested to be appointed or who has / have been proposed as an administrator, administrator with the will annexed, special or temporary administrator of the estate of the decedent, or any person who has been proposed to replace an executor or administrator who has resigned or been removed [ ] is [ ] is not under indictment for or [ ] has [ ] has not been convicted of the murder in either the first or second degree, or of manslaughter, or as an accessory before the fact of such crime committed against the decedent. I / We hereby certify that any person who is entitled to a share in the estate either under the will itself or by operation of law, by descent or distribution or through a share of the decedent's property as a joint tenant or tenant by the entirety [ ] has [ ] has not been charged or convicted of murder in the first or second degree, or of manslaughter (not including vehicular homicide or negligent manslaughter) arising from the death of the decedent. Please indicate the name(s) of the person(s) in the preceding paragraph who have been charged or convicted of any of the crimes listed in connection with the death of the decedent.

Signed under the penalties of perjury this Signature(s):

day of Petitioner - Attorney

,20

CJ- P 50 (3/04)

pcpfc - c.g.f.