Foreign Conservators Sworn Statement {MPC 431}

Docket No. FOREIGN CONSERVATOR'S SWORN STATEMENT In the Interests of: First Name Middle Name Last Name Commonwealth of Massachusetts The Trial Court Probate and Family Court Division Protected Person I, First Name Middle Name (name of foreign conservator) Last Name , as the foreign conservator (G.L. c. 190B, §5-431), state that a Conservator has not been appointed in the Commonwealth of Massachusetts and no petition in a protective proceeding is pending in this Commonwealth for the Protected Person. I hereby file with this Court the following documents: Authenticated copy of the foreign court's order appointing the foreign conservator. Authenticated copy of the foreign court's letters or other documents evidencing or affecting the foreign conservator's authority to act. In addition, I file with this court an authenticated copy of any bond of the foreign conservator or, if none is filed, I certify that none was required. As the foreign conservator and being sworn, I certify that the facts set forth in this statement are true to the best of my knowledge, information, and belief. Date: Signature of Foreign Conservator (Address) (City/Town) (State) (Apt, Unit, No. etc.) (Zip) Primary Phone #: Date: Signature of Attorney for Foreign Conservator Print Name (Address) (City/Town) (State) (Apt, Unit, No. etc.) (Zip) Primary Phone #: BBO #: MPC 431 (5/3011) American LegalNet, Inc. www.FormsWorkFlow.com