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COUNTY[IES] DIVISION DOCKET NO.
MOTION TO DISMISS APPLICATION FOR ASSISTANCE
JV-091 (11/05/2012)
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AFFIDAVIT OF SERVICE
I certify that I have served the within motion to all counsel of record by first-class mail, postage
prepaid.
ORDER OF THE COURT
(for court use only)
TRIAL COURT OF MASSACHUSETTS
JUVENILE COURT DEPARTMENT
4. I request the court dismiss the case for the following reason(s):
Signature
Print Name
Date
Application for Child Requiring Assistance
In Re:
1. I am a party in the above referenced matter which was filed on
Title (Include School District if motion filed by School
District Representative)
3. The fact-finding hearing
has has not occurred.
2. I am the
applicant child parent/legal guardian/custodian of the child.
Date Signature
denied
allowed
After hearing, the motion is
Date Signature of Justice
.