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Massachusetts Small Estate Affidavit | Voluntary Administration Statement

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The Massachusetts small estate affidavit, known also as the ‘Voluntary Administration Statement’ or ‘MPC 170’, may be used by a petitioner in the event that a decedent passes away leaving personal property (no real property) valued at $25,000 or less not counting one motor vehicle. Once it is filled out, it must be submitted with a certified death certificate and will, if any, to the Probate Court representing the county in which the decedent resided at the time of death. In addition, the petitioner must pay a fee of $115.00. There cannot be another probate action open or pending at the time of filing and 30 days must have elapsed since the death of decedent.

Maximum – $25,000

LawsMGL c. 190B, Section 3-1201

How to Write

Step 1 – In the top box on the left, write in the name of the decedent and date of death.

Step 2 – In Section 1, write in the name of decedent and any name that decedent might have used. In addition, write in the address at which decedent resided at the time of his or her death.

Step 3 – In Section 2, write in your name as petitioner, along with your address and phone number. In addition, write in your interest in the estate.

Step 4 – In Section 5, check off the box that best represents the circumstances relating to decedent’s will, if any.

Step 5 – In Section 6, check the box indicating that you have sent a copy of this statement and the death certificate to the Division of Medical Assistance.

Step 6 – On the next page, write in the decedent’s name at the top.

Step 7 – In Section 8, enter in the description of property and the value. Note that you should write in the identification information about one vehicle, but you do not need to include the value. If the decedent had two vehicles in his or her name, the second vehicle would have to be included and valued when calculating the total value of the estate.

Step 8 – Write in the names of people who are either joint owners with deceased or heirs of any property.

Step 9 – On the third page, write in the decedent’s name at the top and sign and date the document.

Step 10 – Make a copy of this document and the death certificate and send it by certified mail to:
Division of Medical Assistance
Estate Recovery Unit.
P. O. Box 15205
Worcester, MA 01615-0205.

Step 11 – The original must be filed with the probate court representing the county in which decedent resided at his or her death, along with a certified death certificate and a will, if any. In addition, a fee of $115 must be paid.


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