CJ-P 82 (4/09)
that the only persons now ascertained whose issue, not now in being, may become interested are
Name Residence
I/We certify that the estate of the deceased exceed $1000 in value.
does
does not
WHEREFORE your petitioner(s) requests that he/she/they may be authorized to make this sale, conveyance and transfer at
private sale or at public auction; upon the following terms:
and to make the investment and application of the proceeds thereof. Your petitioner(s) further request(s) that he/she/they be
authorized to become the purchaser(s) of said real estate.
Moreover, the petitioner(s) certify/ies that MassHealth an interested party is this matter due to:
is
is not
the filing of a written claim against the estate pursuant to G.L. c. 118E. s 32
the filing of a Notice of Claim pursuant to G.L. c. 197, s 9(d)
Notice of this petition has been sent to MassHealth, P.O. Box 15205, Worcester, Massachusetts 01615-0205
Date
Signature of Petitioner 1
Date
Signature of Petitioner 2
Print Name Residence Relationship Check if Applicable
Sign if you assent to the
Petition
Incompetent
Minor
Incompetent
Minor
The undersigned, being all the persons interested, assent to the above petition.
Print Name
Print Name