Petition For Formal {MPC 160}

PETITION FOR FORMAL PROBATE OF A WILL ADJUDICATION OF INTESTACY APPOINTMENT OF A PERSONAL REPRESENTATIVE OTHER: PURSUANT TO G. L. c. 190B, § 3-402 Original Form Estate of: First Name Middle Name Docket No. Commonwealth of Massachusetts The Trial Court Probate and Family Court Amended Form Division Last Name Date of Death: I. GENERAL INFORMATION The Petitioner(s) (hereafter "Petitioner"), an interested person, makes the following statements: 1. Information about the Decedent: Name: First Name Middle Name Name Last Name Age at death Also known as: Street Address: (Address) (Apt, Unit, No. etc.) (City/Town) (City/Town) (State) (Zip) The Decedent was domiciled in , . (State) A death certificate issued by a public officer is in the possession of the court or accompanies this Petition. A death certificate issued by a public officer is not in the possession of the court and does not accompany this Petition. The circumstances which make it impossible for a death certificate to be provided are (See G. L. c. 190B, §§ 3-402(b), 1-107): 2. Information about the Petitioner: Name: First Name M.I. Last Name (Address) (Apt, Unit, No. etc.) (Address) (Apt, Unit, No. etc.) (City/Town) (City/Town) (State) (State) (Zip) (Zip) Mailing Address, if different: Primary Phone #: The Petitioner's interest in the estate is as follows (e.g., Personal Representative named in a will, surviving spouse, heir, devisee, Public Administrator, creditor, etc. See G. L. c. 190B, § 1-201(24)): 3. This Petition is filed within the time period permitted by law. See G. L. c. 190B, § 3-108. Three years or less have passed since the Decedent's death, or the following circumstances authorize tardy proceedings (include statutory reference): FORM ALERT: Do not use this form to file a late probate proceeding pursuant to G. L. c. 190B, § 3-108(4). Use form MPC 161. MPC 160 (4/15/16) American LegalNet, Inc. www.FormsWorkFlow.com page 1 of 4 4. Venue for this proceeding is proper in this county because on the date of death, the Decedent: was domiciled in this county. (Address) was not domiciled in Massachusetts, but had property located in this county at: (Apt, Unit, No. etc.) (City/Town) (State) (Zip) 5. The Petitioner shall give notice once by citation to the Division of Medical Assistance. To do so, the Petitioner shall send a copy of the citation when issued by the court together with a copy of this Petition and death certificate by certified mail at least fourteen (14) days before the return day to the Division of Medical Assistance, Estate Recovery Unit, P.O. Box 15205, Worcester, MA 01615-0205. For specific details, see the citation's Order of Notice. II. PERSONS INTERESTED IN THE ESTATE 6. The Decedent's surviving spouse, children, heirs at law and devisees (if any), so far as known or ascertainable with reasonable diligence by the Petitioner are as stated in form MPC 162 Surviving Spouse, Children, Heirs at Law AND if the Decedent died with a will, form MPC 163 Devisees incorporated herein. There are additional heirs at law who are not known to the Petitioner. FORM ALERT: Failure to submit this information will result in a delay in processing your case. III. TESTACY STATUS 7. The Decedent died (select one): Intestate (without a will) After the exercise of reasonable diligence, the Petitioner is unaware of any unrevoked testamentary instrument relating see attached statement of why such an instrument is not being probated. to property in Massachusetts, or Testate (with a will) The date of the Decedent's last will is The dates of all codicils are (select one of the following): The original will is in the possession of the court or accompanies this Petition. The original will is lost, destroyed or otherwise unavailable and a copy of the original will accompanies this Petition OR a statement of its contents is attached and incorporated herein. The will has been probated in the state or country of An authenticated copy of the will and proof of its probate are filed with this Petition. The will and any codicils are referred to as the will. The Petitioner, to the best of his or her knowledge, believes the will was validly executed. After the exercise of reasonable diligence, the Petitioner is unaware of any instrument revoking the will and believes that the will is the Decedent's last will. IV. APPOINTMENT OF PERSONAL REPRESENTATIVE (if requested) 8. The Petitioner requests that the following qualified person, who is 18 years of age or older, be appointed Personal Representative: Name of other(s): First Name M.I. Last Name . . Self only. Self and other(s): Other(s): (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Mailing Address, if different: (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Primary Phone #: MPC 160 (4/15/16) American LegalNet, Inc. www.FormsWorkFlow.com page 2 of 4 9. Select all that apply: All or some of the nominees have priority for appointment: by statute. See G. L. c. 190B, § 3-203. by renunciation and/or nomination. Persons with higher or equal rights to appointment are: First Name M.I. Last Name FORM ALERT: Any required renunciations/nominations using form MPC 455 must accompany this Petition. The nominee(s) without priority for appointment are: First Name M.I. Last Name Persons with priority have failed to request appointment or to nominate the above nominee and administration is necessary. 10. Select one of the following: No court has appointed a Personal Representative and no such appointment proceeding is pending in Massachusetts or elsewhere. A court has appointed a Personal Representative, whose appointment has not been terminated, or an appointment proceeding is pending in the State of address is: First Name (Address) (Apt, Unit, No. etc.) M.I. (City/Town) Last Name (State) (Zip) and the Personal Representative's name and 11. Select one of the following: A bond with sureties in the penal sum amount of $ A bond without sureties has been or will be filed and is permissible because: The will waives sureties on the bond and no interested person has demanded that a bond with sureties be filed. All devisees (if a will is filed) or heirs (if no will is filed) have waived sureties in writing using form MPC 455 and all waivers are filed with this Petition or are in the possession of the court. FORM ALERT: All persons seeking appointment must file a bond using form MPC 801. has been or will be filed. 12. The Petitioner requests (Select one of the following): Unsupervised administratio