MPC 301 (5/30/11) REQ
REQUEST FOR COUNSEL
Commonwealth of Massachusetts
The Trial Court
Probate and Family Court
Docket No.
RESPONDENT
In the Interests of:
Last Name
First Name
Division
NOTICE: Massachusetts General Law c. 190B, 5-106 provides that an attorney shall be appointed for the
Respondent upon request of any person. "If the ward, incapacitated person or person to be protected
has adequate resources, his or her counsel shall be compensated from the estate, unless the court shall
order that such compensation be paid by the petitioner. Counsel for any indigent ward, incapacitated
person or person to be protected shall be compensated by the Commonwealth."
§
I,
First Name
Last Name
Middle Name
hereby request the Court appoint
an attorney for:
Me as I am the person named above as RESPONDENT.
(optional) I am 14 or more years of age and I request the Court consider appointing the following attorney to represent me:
.
The person named above as RESPONDENT.
My relationship to the RESPONDENT is
.
Date
Signature of Requesting Party
(Address)
(Apt, Unit, No. etc.)
(City/Town)
(State)
Primary Phone #
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