Application For Generating Appointments In Superior Court

The Commonwealth of Massachusetts THE ADMINISTRATIVE OFFICE OF THE SUPERIOR COURT APPLICATION FOR FEE GENERATING APPOINTMENTS IN THE SUPERIOR COURT Name Address City Phone Number State Fax Number BBO# Zip Code E-Mail I certify: Date of Admission that I remain in good standing to practice before the courts of the Commonwealth of Massachusetts; that I have not been convicted of any felony; that I have currently in effect professional liability insurance with coverage of $100,000 or more; and that I have at least ten years experience as a practicing attorney within the Commonwealth. I request that I be appointed as a: Master Receiver Arbitrator Guardian Ad Litem I request and will accept appointments from the Superior Court in the following counties (not more than four): I agree that if I am appointed as a master, receiver, arbitrator or guardian ad litem, and the court or attorney/party in the case requests a certificate of my professional liability insurance, that I will provide it within seven days of the request. I have attached a letter of interest and a copy of my resume to this application. I certify under the penalties of perjury that all of the above information is true. Current Date 9/7/13 Signature PLEASE SUBMIT APPLICATIONS TO: Susan K. Marcucci, Regional Coordinator, Superior Court Administrative Office, Three Pemberton Square, Boston, MA 02108 or via email at susan.marcucci@jud.state.ma.us. American LegalNet, Inc. www.FormsWorkFlow.com