MPC 431 (5/30/11)
FOREIGN CONSERVATOR'S SWORN
STATEMENT
Commonwealth of Massachusetts
The Trial Court
Probate and Family Court
Docket No.
In the Interests of:
Last Name
First Name
Middle Name
Protected Person
I,
First Name
Last Name
Middle Name
(name of foreign conservator)
, as the foreign conservator
(G.L. c. 190B, §5-431), state that a Conservator has not been appointed in the Commonwealth of Massachusetts and no
petition in a protective proceeding is pending in this Commonwealth for the Protected Person. I hereby file with this Court the
following documents:
Authenticated copy of the foreign court's order appointing the foreign conservator.
Authenticated copy of the foreign court's letters or other documents evidencing or affecting the foreign conservator's
authority to act.
In addition, I file with this court an authenticated copy of any bond of the foreign conservator or, if none is filed, I certify that
none was required.
As the foreign conservator and being sworn, I certify that the facts set forth in this statement are true to the best of my
knowledge, information, and belief.
Date:
Signature of Foreign Conservator
(Address)
(Apt, Unit, No. etc.)
(City/Town)
(State)
(Zip)
Primary Phone #:
Date:
Signature of Attorney for Foreign Conservator
(Address)
(Apt, Unit, No. etc.)
(City/Town)
(State)
(Zip)
Primary Phone #:
BBO #:
Print Name
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