MPC 500 (5/30/11)
of
page
CERTIFICATE OF SERVICE OF:
Commonwealth of Massachusetts
The Trial Court
Probate and Family Court
Docket No.
(type of pleading)
RESPONDENT
Last Name
First Name
Middle Name
Division
On Respondent:
I,
, a disinterested person over the age of eighteen (18), hereby
certify under the penalties of perjury that on
(date)
I served in hand a copy of
on
(Respondent's name)
at
(address)
Date:
[Fill in the blank lines, check the boxes that show how the above was served, and sign where indicated.]
(name)
Signature:
On Other Interested Persons:
I,
, hereby certify under the penalties of perjury that a copy of
was served:
(name)
On:
by
certified/registered mail
first-class mail
hand delivery
(address)
at:
(name)
Date
On:
by
certified/registered mail
first-class mail
hand delivery
(address)
at:
(name)
Date
On:
by
certified/registered mail
first-class mail
hand delivery
(address)
at:
(name)
Date
The following interested persons' assents have been filed with the court:
Date:
Signature:
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