Fillable Mpc441 Notarized And Verified Consent Or Nomination Of Minor Fill (Commonwealth of Massachusetts)

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Mpc441 Notarized And Verified Consent Or Nomination Of Minor Fill (Commonwealth of Massachusetts)

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BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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MPC 441 (5/30/11) NVC
of
page
NOTARIZED AND VERIFIED CONSENT
OR NOMINATION BY MINOR
Commonwealth of Massachusetts
The Trial Court
Probate and Family Court
Docket No.
In the Interests of:
Last Name
Middle Name
Minor
Division
I,
First Name
Last Name
Middle Name
(full name of minor) am 14
years of age or older and I:
Consent to the appointment of
(full name) as my guardian(s) pursuant to G.L. c. 190B, 5-203.
First Name
Last Name
M.I.
§
Do not consent to the appointment of
(full name) as my guardian(s) pursuant to G.L. c. 190B, 5-203.
First Name
Last Name
M.I.
§
Nominate
First Name
Last Name
M.I.
(full name), as my
guardian(s) pursuant to G.L. c. 190B, §5-207.
VERIFICATION AND ACKNOWLEDGMENT
I swear/affirm under oath that I have read the foregoing Consent or Nomination by Minor and that the statements set forth
therein are true and correct to the best of my knowledge.
Date
Signature of Minor
(Address)
(Apt, Unit, No. etc.)
(City/Town)
(State)
(Zip)
Primary Phone #:
NOTARIZATION
, ss
Date
On this
day of
, 20
,
personally appeared
before me, the undersigned notary public, and proved to me through satisfactory evidence of identification, which was
, to be the person whose name is signed on the preceding or attached document
in my presence.
Signature of Notary Public
(Print name)
My Commission Expires
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Mpc441 Notarized And Verified Consent Or Nomination Of Minor Fill (Commonwealth of Massachusetts)

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Completed 26 July 2020

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