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Commonwealth of Massachusetts PROBATE AND FAMILY COURT DEPARTMENT Gina L. DeRossi Register Bristol REQUEST FOR UNCONTESTED ASSIGNMENT* Division Docket No____________ Supplemental Probate Court Rule 401 requires a current financial statement be on file from a person requesting a hearing involving financial orders. Please assign for hearing ________________________________________________________________ Plaintiff V. ________________________________________________________________ Defendant Place of Hearing: ( ( ( ( ) ) ) ) At the earliest convenient time and place At Fall River At New Bedford At Taunton Type of Case: For ADA accommodation needs please call (508) 672-4669 x204 The following papers must be on file before cases can be assigned for hearing ( ) Divorce (If the ground for divorce is an irretrievable breakdown of marriage: pursuant to M.G.L. C 208 § 1B then the submission of this form should not occur until after 6 months from the date of filing the original complaint for divorce) ( ) Summons or Return of Service ( ( ( ( ( ) Separate Support ) Civil Action ) Contempt ) Modification ) Other ___________________________________ ( ( ( ( ( ( ) Marriage Certificates ) Birth Certificate ) Statistical Form R408 ) Medical Certificate ) Affidavit of Petitioner ) Other ____________________________ Parenting Education Classes are complete and certificates are filed One of the parties requires interpreter services ( ) Yes ( ) Yes One of the parties is on welfare or is making application for welfare ( ) Yes □ Copy of this request has been mailed to the following named Attorneys / Pro Se Litigants in this action ( ) No ( ) No Language:____________ Country of Origin ______________ ( ) No DATE_______________________ Requested by: Name:_____________________________________ Name:_____________________________________ Address: ___________________________________ Address:___________________________________ Street City Zip Phone:_____________________________________ Street City Zip Phone:_____________________________________ *This form should not be used for mark-up of temporary orders and motions. Instead, affidavits of notice should be filed in accordance with the rules, after an available time and place for hearing has been obtained from the Register's Office. FOR REGISTER'S USE ONLY ACTION The above-entitled matter has been : □ Assigned for Hearing at _________________________________________on__________________________20_______ □ □ Counsel notified by mail / telephone Date of notice: ____________________________ Returned without action. Data incomplete. See above. bc-405B R6/2003 – Register of Probate ______________ Clerk's Initials