Commonwealth of Massachusetts
Division
The Trial Court Probate and Family Court Department
Docket No.
UNIFORM COUNSEL CERTIFICATION FORM
Case Caption: I am the attorney-of-record for: plaintiff defendant petitioner respondent in the above-entitled matter.
In accordance with Rule 5 of the Supreme Judicial Court Uniform Rules on Dispute Resolution (SJC Rule 1:18) which states in part: "...Attorneys shall provide their clients with this information about court-connected dispute resolution services; discuss with their clients the advantages and disadvantages of the various methods of dispute resolution; and certify their compliance with this requirement on the civil cover sheet or its equivalent."
I hereby certify that I have complied with this requirement.
(Signature of Attorney-of-Record)
(Print name)
B.B.O. # Date
CCF (4/07)
C.G.F