JV-021 (Rev. 12/18/2013)
APPOINTMENT OF AGENT
(SEALED)
Trial Court of Massachusetts
Juvenile Court Department
I, of
appoint
of
as my agent and do stipulate and agree that service of legal process against me by
of
seeking enforcement of the post-adoption agreement entered into on
shall have the like effect as if made on me personally. I hereby revoke any previous appointment of agent.
Signed in the presence of
(Name) (Street and No.)
(City or Town) (County) (State) (Zip Code)
(Street and No.)(Name)
(Zip Code)(State)(County)(City or Town)
(Zip Code)(State)(County)(City or Town)
(Street and No.)(Name)
Date: Signature:
(PRINCIPAL)
Signature:
(WITNESS)
Division
ACCEPTANCE
I, of
accept
the appointment.
If the agent is no longer able to serve, the person nominating the agent must name a new agent by completing another
appointment of agent form and filing the form with the court.
(AGENT)
Signature:Date:
(Street and No.)(Name)
(Zip Code)(State)(County)(City or Town)
(Name and Address of Witness)
(Date)
