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SURVIVING SPOUSE, CHILDREN, Docket No. Comnidiig §eT of ‘Wiasé augers
1e tial Court’
M
ume:
HEIRS AT LAW Probate and Family Court
G. L. c. 190B, § 3-301
[x] Original Form [Amended Form
Estate of:
Carole Ann Painter Middlesex Division
First Name Middle Name Last Name
Date of Death: October 22, 2023
FORM USE: This form must be used to identify a Decedent's surviving spouse, children and heirs at law. Heirs at law are
persons entitled to receive the Decedent's property under the intestacy succession laws if there is no will. For dates of death
on or after March 31, 2012, the Massachusetts Uniform Probate Code, G. L. c. 190B, § 2-101, et seq., should be consulted.
For deaths prior to that date, see applicable law.
Instructions: Complete ALL applicable sections of this form. For step by step instructions on how to complete this form, click
on the instructions link above or see Instructions MPC 958.
ALL PETITIONERS MUST COMPLETE LINE 1 AND LINE 2.
The Decedent [x] did not leave a surviving spouse. O left as urviving spouse:
2 a. The Decedent [] did not have children (biological or adopted) [x] had the following children (biological or adopted):
IF ING
106 W Acton Road OYes [No OYes
Edward M. Painter
Stow, MA 01775
7700 81st Place SE OYes [No OYes
Helen P. Kelly
Mercer Island, WA 98040-5926
DYes (No DYes
(J b. The surviving spouse has surviving descendants (children, grandchildren, etc.) who are not descendants of the
Decedent.
Complete line 3 ONLY if the Decedent left children in line 2a who are also heirs at law.
3. [%] a. Allof the children listed in 2a survived the Decedent.
[J b. The following children listed in 2a died before the Decedent:
c. The predeceased child(ren) listed in 3b:
CO did not leave surviving descendants (children, grandchildren, etc.) (biological or adopted).
Cleft the following surviving descendants (children, grandchildren, etc.) (biological or adopted):
MPC 162 (4/15/16) SCH page 4 of 3
DocuSi lopeID: AC6BEC08-1ESB-47CC-A3B: SDDAFDB\ vt
eM
CyYes
DYes
Complete line 4 ONLY if the Decedent left NO surviving descendants (children, grandchildren, etc.). Otherwise STOP
and go to line 7 and line 8.
4. The Decedent O did not leave a surviving Parent, oO left a surviving parent or parents:
OF ENT(S DI
For deaths on or after March 31, 2012:
Complete line 5 ONLY if the Decedent left NO surviving spouse, descendants (children, grandchildren, etc.) or parents.
Otherwise STOP and go to line 7 and line 8.
For deaths prior to March 31, 2012:
Complete line 5 ONLY if the Decedent left NO surviving descendants (children, grandchildren, etc.) or parents.
Otherwise STOP and go to line 7 and line 8.
5 a. The Decedent [[] did not leave a surviving sibling. [[] left the following surviving sibling(s) (biological or adopted,
whole or halt blood):
Bl MIN
LYes
CYes
b. (] One or more of the Decedent's siblings died before the Decedent and left surviving descendants (biological or
adopte:
(CYes
For deaths on or after March 31, 2012:
Complete line 6 ONLY if the Decedent left NO surviving spouse, descendants (children, grandchildren, etc.), parents,
siblings or descendants of any predeceased sibling. Otherwise STOP and go to line 7 and line 8.
For deaths prior to March 31, 2012:
Complete line 6 ONLY if the Decedent left NO surviving descendants (children, grandchildren, etc.), parents, siblings or
descendants of any predeceased sibling. Otherwise STOP and go to line 7 and line 8.
6. List the heirs as defined by the law in effect on the Decedent's date of death. (Select one):
Cd The heirs at law are as follows:
For assistance, see the Instructions and the Massachusetts Degree of Kinship Chart (MPC 960). See also line 7 and
line 8.
MPC 162 (4/15/16) SCH page 2 of 3
DocuSignEr 1D: AC6BEC08-1E5B-47CC-A3B3-CC83DDAFDBC.
SHii
iE Mi
LYes
(Yes
LJ After a reasonable diligent search, the heirs at law are unknown or unascertainable. (Requires a formal proceeding.)
ALL PETITIONERS MUST COMPLETE LINE 7 AND LINE 8, if applicable.
7. NONE of the Decedent's heirs at law (surviving spouse, children, etc.) are under a legal disal ity except for:
EPRESEN’ NAME/ADDRESS
HEIR
{Minor List age: [Guardian
[J Incapacitated or protected person | ["]Conservator
(adjudicated or alleged) [_]Unrepresented*
(_]Minor List age: (Guardian
(J Incapacitated or protected person | [_]Conservator
(adjudicated or alleged) [J Unrepresented*
8. NONE of the heirs at law (surviving spouse, children, etc.) who survived the Decedent are deceased at the time of this
filing except for
[AME/ADDRE:
[Personal Representative
(Required for an informal proceeding)
(_] Unrepresented
(Formal proceeding required)
[Personal Representative
(Required for an informal proceeding)
{_] Unrepresented
(Formal proceeding required)
SIGNED UNDER THE PENALTIES OF PERJURY
| certify under the penalties of perjury that the foregoing we true to the best of my knowledge and belief.
Date: 3/5/2024
Signature of Petitioner
Edward M. Painter
(Print name)
MPC 162 (4/15/16) SCH page 3 of
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rt SURVIVING SPOUSE, CHILDREN, Docket No. Comnidiig §eT of ‘Wiasé augers 1e tial Court’ M ume: HEIRS AT LAW Probate and Family Court G. L. c. 190B, § 3-301 [x] Original Form [Amended Form Estate of: Carole Ann Painter Middlesex Division First Name Middle Name Last Name Date of Death: October 22, 2023 FORM USE: This form must be used to identify a Decedent's surviving spouse, children and heirs at law. Heirs at law are persons entitled to receive the Decedent's property under the intestacy succession laws if there is no will. For dates of death on or after March 31, 2012, the Massachusetts Uniform Probate Code, G. L. c. 190B, § 2-101, et seq., should be consulted. For deaths prior to that date, see applicable law. Instructions: Complete ALL applicable sections of this form. For step by step instructions on how to complete this form, click on the instructions link above or see Instructions MPC 958. ALL PETITIONERS MUST COMPLETE LINE 1 AND LINE 2. The Decedent [x] did not leave a surviving spouse. O left as urviving spouse: 2 a. The Decedent [] did not have children (biological or adopted) [x] had the following children (biological or adopted): IF ING 106 W Acton Road OYes [No OYes Edward M. Painter Stow, MA 01775 7700 81st Place SE OYes [No OYes Helen P. Kelly Mercer Island, WA 98040-5926 DYes (No DYes (J b. The surviving spouse has surviving descendants (children, grandchildren, etc.) who are not descendants of the Decedent. Complete line 3 ONLY if the Decedent left children in line 2a who are also heirs at law. 3. [%] a. Allof the children listed in 2a survived the Decedent. [J b. The following children listed in 2a died before the Decedent: c. The predeceased child(ren) listed in 3b: CO did not leave surviving descendants (children, grandchildren, etc.) (biological or adopted). Cleft the following surviving descendants (children, grandchildren, etc.) (biological or adopted): MPC 162 (4/15/16) SCH page 4 of 3 DocuSi lopeID: AC6BEC08-1ESB-47CC-A3B: SDDAFDB\ vt eM CyYes DYes Complete line 4 ONLY if the Decedent left NO surviving descendants (children, grandchildren, etc.). Otherwise STOP and go to line 7 and line 8. 4. The Decedent O did not leave a surviving Parent, oO left a surviving parent or parents: OF ENT(S DI For deaths on or after March 31, 2012: Complete line 5 ONLY if the Decedent left NO surviving spouse, descendants (children, grandchildren, etc.) or parents. Otherwise STOP and go to line 7 and line 8. For deaths prior to March 31, 2012: Complete line 5 ONLY if the Decedent left NO surviving descendants (children, grandchildren, etc.) or parents. Otherwise STOP and go to line 7 and line 8. 5 a. The Decedent [[] did not leave a surviving sibling. [[] left the following surviving sibling(s) (biological or adopted, whole or halt blood): Bl MIN LYes CYes b. (] One or more of the Decedent's siblings died before the Decedent and left surviving descendants (biological or adopte: (CYes For deaths on or after March 31, 2012: Complete line 6 ONLY if the Decedent left NO surviving spouse, descendants (children, grandchildren, etc.), parents, siblings or descendants of any predeceased sibling. Otherwise STOP and go to line 7 and line 8. For deaths prior to March 31, 2012: Complete line 6 ONLY if the Decedent left NO surviving descendants (children, grandchildren, etc.), parents, siblings or descendants of any predeceased sibling. Otherwise STOP and go to line 7 and line 8. 6. List the heirs as defined by the law in effect on the Decedent's date of death. (Select one): Cd The heirs at law are as follows: For assistance, see the Instructions and the Massachusetts Degree of Kinship Chart (MPC 960). See also line 7 and line 8. MPC 162 (4/15/16) SCH page 2 of 3 DocuSignEr 1D: AC6BEC08-1E5B-47CC-A3B3-CC83DDAFDBC. SHii iE Mi LYes (Yes LJ After a reasonable diligent search, the heirs at law are unknown or unascertainable. (Requires a formal proceeding.) ALL PETITIONERS MUST COMPLETE LINE 7 AND LINE 8, if applicable. 7. NONE of the Decedent's heirs at law (surviving spouse, children, etc.) are under a legal disal ity except for: EPRESEN’ NAME/ADDRESS HEIR {Minor List age: [Guardian [J Incapacitated or protected person | ["]Conservator (adjudicated or alleged) [_]Unrepresented* (_]Minor List age: (Guardian (J Incapacitated or protected person | [_]Conservator (adjudicated or alleged) [J Unrepresented* 8. NONE of the heirs at law (surviving spouse, children, etc.) who survived the Decedent are deceased at the time of this filing except for [AME/ADDRE: [Personal Representative (Required for an informal proceeding) (_] Unrepresented (Formal proceeding required) [Personal Representative (Required for an informal proceeding) {_] Unrepresented (Formal proceeding required) SIGNED UNDER THE PENALTIES OF PERJURY | certify under the penalties of perjury that the foregoing we true to the best of my knowledge and belief. Date: 3/5/2024 Signature of Petitioner Edward M. Painter (Print name) MPC 162 (4/15/16) SCH page 3 of