THE COMMONWEALTH OF MASSACHUSETTS
Housing Court Department
_______________________Division
________________________Address
________________________________
__________________,SS:
No. / / /C / V / / / / / /
STATEMENT OF MATERIAL FACTS
(Please Print)
___________________________
Plaintiff(s) Address: ___________________________
___________________________
Tel: ___________________________
_________________________________ Address: ___________________________
Defendant(s)
___________________________
Tel: ___________________________
BRIEFLY STATE THE FACTS:
Signed under the pains and penalties of perjury on: __________________________
Date:
Signature: _____________________________________
(select court)
(select county)
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