JV-135 (Rev. 11/05/2018)
AFFIDAVIT OF NOTICE BY PUBLICATION
AND/OR CERTIFIED OR REGISTRED MAIL
DOCKET NUMBER
Trial Court of Massachusetts
Juvenile Court Department
DIVISION
In the Matter of:
1. Complete this section if you were ordered to give notice by publication.
(You must complete Section 2 below
if you were also ordered to give notice by certified or registered mail, return receipt requested.)
I, , hereby certify under the pains and penalties of
perjury that in accordance with the order of this Court, I caused to be published the Order of Notice in
this matter: Check One: successive weeks in the
, a newspaper published in
, said publication(s) being made
on ; on ; and on ;
a clipping/clippings of said Order of Notice of publication(s) from the newspaper page(s) in which said
publication(s) appeared being attached hereto and made a part of this affidavit.
once once in each of
(name of person who caused service by publication)
(name of newspaper)
(date of third publication, if applicable)(date of second publication, if applicable)(date of first publication)
(mailing address of newspaper)
2. Complete this section if you were ordered to give notice by certified or registered mail. (This section must
be completed if (1) you were also ordered to give notice by publication or, (2) you were only ordered to give notice by certified
or registered mail, return receipt requested.)
I hereby certify that I provided a copy of the summons or notice and a copy of the petition as ordered to the
following:
I hereby certify that I was unable to provide a copy of the summons or notice and a copy of the petition as
ordered for the following reason(s):
____________________________________________________________________________________
____________________________________________________________________________________
Print Name:
B.B.O. No.:
Signature:
(if applicable)
Date:
(address)
(name) (address)
(name)
