COUNSEL CERTIFICATION FORM
Pursuant to SJC RULE 1:18
DOCKET NUMBER
CASE NAME:
Trial Court of Massachusetts
The Superior Court
COURT NAME & ADDRESS
VS
I hereby certify that in accordance with Rule 5 of the Supreme Judicial Court Uniform Rules on Dispute Resolution (SJC Rule
1:18), I have complied with the requirements of the rule requiring that I provide my clients with information about court-
connected dispute resolution services and discuss with them the advantages and disadvantages of the various methods of
dispute resolution.
rev: 01/09/2019
County
Signature:
Dated:
Print name:
Address:
BBO #:
I am attorney of record for
plaintiff defendant in the above-entitled matter.
Clerk of Courts