Fillable Commonwealth of Massachusetts Affidavit Under Summary Process Rule 10(d)(ii)

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Commonwealth of Massachusetts Affidavit Under Summary Process Rule 10(d)(ii)

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The Commonwealth of Massachusetts Affidavit Under Summary Process Rule 10(d)(ii) form is 1 page long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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COMMONWEALTH OF MASSACHUSETTS
__________________
SS: HOUSING COURT DEPARTMENT
_______________________
DIVISION
/ / /
SP-_ / / / / /
_____________________________________
Plaintiff/Landlord
VS.
______________________________________
Defendant/Tenant
AFFIDAVIT UNDER SUMMARY PROCESS RULE 10(d)(ii)
I, __________________________________________________, state for an affidavit under
penalties of perjury, and from my own personal knowledge, that I am the ___________
______________________________in this action, that the defendant
-tenant is not an infant
or incompetent person, and is not in the military service as defined in the
Servicemembers Civil Relief Act, but is instead residing at
__________________________
__________________ that no payments have been made by or on
behalf of the tenant after filing the summary process Complaint, except
_____________________, that the tenant owes rent or use and occupancy charges at the
rate of $ ______________
per _______________ for the period from ______________________________________________
through __________________________________________as follows:
Amount: $_________________ Date: ____________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
and that there remains due and owing a balance of $ _________________ which balance
includes only unpaid rent or use and occupancy charges and does not include court costs
or other claims, debts, damages or expenses.
_______________________________________
Signature and Date:
______________________________________
Name of Plaintiff-Landlord:
________________________________________
Address and Telephone:
_______________________________________
(select county)
(select court)
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Commonwealth of Massachusetts Affidavit Under Summary Process Rule 10(d)(ii)

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Completed 17 May 2020

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