Fillable Mpc475 Suspicious Death Affidavit Fill (Commonwealth of Massachusetts)

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Mpc475 Suspicious Death Affidavit Fill (Commonwealth of Massachusetts)

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BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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MPC 475 (3/19/12) AFSD
of
page
SUSPICIOUS DEATH AFFIDAVIT
PURSUANT TO G.L. c. 190B, § 2-803
Commonwealth of Massachusetts
The Trial Court
Probate and Family Court
Docket No.
Estate of:
Last Name
Middle Name
Date of Death:
Division
1.
I hereby certify that, except as noted in paragraph 3 below, none of the following: The Personal Representative named in
the Will, the Special Personal Representative whose appointment is sought, the person(s) who has requested to be
appointed or been proposed as a Personal Representative or, any person proposed to replace the Personal
Representative who has resigned or been removed, did feloniously and intentionally kill the Decedent.
I hereby certify that, except as noted in paragraph 3 below, no person who is entitled to a share in the estate either under
the Will itself or by operation of law, by descent or distribution, elective share, omitted spouse or child's share, exempt
property, family allowance or through a share of the Decedent's property as a joint tenant or tenant by the entirety, did
feloniously and intentionally kill the Decedent.
2.
3.
Indicate the name(s) of the person(s) described in the preceding paragraphs who has charges pending, is under
indictment, has been charged or convicted of any of the crimes listed in connection with the death of the Decedent:
Name:
First Name
Last Name
M.I.
SIGNED UNDER THE PENALTIES OF PERJURY
I certify under the penalties of perjury that the foregoing statements are true to the best of my knowledge and belief.
Signature of Petitioner
Date
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Mpc475 Suspicious Death Affidavit Fill (Commonwealth of Massachusetts)

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Completed 26 July 2020

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