[Notice of Limited Appearance (TC005 01/31/2019 JISD)]
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TRIAL COURT OF
MASSACHUSETTS
NOTICE OF LIMITED APPEARANCE
Trial Court Rule XVI
COURT
TRIAL COURT USE ONLY
DOCKET NUMBER
CASE NAME / In the Matter of:
Plaintiff / Petitioner
Defendant / Respondent
BMC:
District:
Housing:
Land:
Probate & Family:
Superior:
Attorney,
ADR:
Motion:
Trial
Hearing:
and Party,
have both signed a written agreement for the Attorney to represent the Party on a limited basis in the following court
event(s) or discrete issue(s) as described below (
List event date where applicable).
Other Court Event:
Others:
(Must Specify)
Date:
Date:
Date:
Date:
Date:
Date:
SIGNATURE OF ATTORNEY
ATTORNEY CERTIFICATION
NAME (FIRST, MIDDLE, LAST)
B.B.O. NUMBER
FIRM OR AGENCY NAME (IF APPLICABLE)
OFFICE OR HOME PHONE NUMBER
MOBILE PHONE NUMBER
STREET ADDRESS APT/UNIT #
FAX NUMBER
CITY/TOWN STATE ZIP CODE E-MAIL ADDRESS
I certify that I have completed an approved LAR information session as required, and that I have signed a
written agreement with the Party above to provide the limited representation in this matter as described
above. I also certify that I have served this Notice of Limited Appearance on this Party, all counsel
and all parties not represented by counsel.
Notice to all other parties: For all matters listed above, both the LAR attorney and the Party must be
served. See Trial Court Rule XVI.
X
DATED
SIGNATURE OF PARTY
X
DATED
