12.18
Trial Court of Massachusetts
COUNTY/COURT DIVISION
PLAINTIFF DEFENDANT
AFFIDAVIT OF ADDRESS
RE-VERIFICATION UPON REQUEST
FOR DEFAULT JUDGMENT
Mass. R. Civ. P. 55.1(d)
DOCKET NO.
The affiant in this action states that the defendant's residential address was re-verified by within three months prior to the
request for default judgment by at least one of the following three methods, as indicated below (check 1, 2 or 3):
1. Receipt of correspondence from the defendant with that return address OR other verification from the defendant
within the three-month period that such address is current. Such other verification from defendant was obtained as
follows:
2. Certified mail receipt signed by the defendant with that address within the three-month period.
Date of this verification:
Date of this verification:
3. Letter sent by first-class mail to that address for the defendant that has not been returned to sender by the postal
service, AND verifying the same address as current using a paid subscriber-based commercial online database
AND:
A municipal record, such as a street list or tax records, namely:
OR
A state motor vehicle registry record, namely:
Date of this verification:
The affiant also states that the documents reflecting the verification method(s) indicated above are attached to this
affidavit.
SIGNED UNDER THE PENALTIES OF PERJURY
AFFIANT
X
THIS FORM MAY BE REQUIRED IN CASES SUBJECT TO MASS. R. CIV. P. 55.1(d)
Neither a municipal record nor a state motor vehicle registry record is available.
DATE
If any database or municipal or state record used shows more than one address for the defendant during the last 12
months, the basis for selecting the address(es) to be used for service is:
The name, position, and employer of the affiant:
