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Docket No. Division The Commonwealth of Massachusetts Department of Public Health Registry of Vital Records and Statistics CERTIFICATE OF ABSOLUTE DIVORCE OR ANNULMENT G.L. Chap. 208 Sec. 46 R-408 Husband-Name First Middle Last HUSBAND Usual Residence-Street Address City Town or Location 2a. 2b. County State Date of Birth mo. day yr. Number of this Marriage 1st 2nd specify 2c* 2d. Wife-Name Maiden Name 5a* WIFE 5b. 6a* 6b. 6c* 6d. Date of this Marriage mo. day yr. Number of Children Born Alive of this Marriage 10a* 10b. FOR COURT USE ONLY County of Judgment Title of Court 11a* JUDGMENT Date of Judgment Nisi Type of Judgment - Date of Judgment Absolute mo. day yr. Divorce or Annulment Docket Number Name of Plaintiff Cause for which Granted Signature of Certifying Official Title of Official 18a* 18b. County State Date of Birth mo. day yr. Number of this Marriage 1st 2nd specify 2c* 2d. Wife-Name Maiden Name 5a* WIFE 5b. 6a* 6b. 6c* 6d. Date of this Marriage mo. day yr. Number of Children Born Alive of this Marriage 10a* 10b. 6a* 6b. 6c* 6d. Date of this Marriage mo. day yr. Number of Children Born Alive of this Marriage 10a* 10b. FOR COURT USE ONLY County of Judgment Title of Court 11a* JUDGMENT Date of Judgment Nisi Type of Judgment - Date of Judgment Absolute mo. FOR COURT USE ONLY County of Judgment Title of Court 11a* JUDGMENT Date of Judgment Nisi Type of Judgment - Date of Judgment Absolute mo. day yr. Divorce or Annulment Docket Number Name of Plaintiff Cause for which Granted Signature of Certifying Official Title of Official 18a* 18b. County State Date of Birth mo. day yr. Number of this Marriage 1st 2nd specify 2c* 2d. Wife-Name Maiden Name 5a* WIFE 5b. 6a* 6b. 6c* 6d. Date of this Marriage mo. day yr. Number of Children Born Alive of this Marriage 10a* 10b. FOR COURT USE ONLY County of Judgment Title of Court 11a* JUDGMENT Date of Judgment Nisi Type of Judgment - Date of Judgment Absolute mo. 6a* 6b. 6c* 6d. Date of this Marriage mo. day yr. Number of Children Born Alive of this Marriage 10a* 10b. FOR COURT USE ONLY County of Judgment Title of Court 11a* JUDGMENT Date of Judgment Nisi Type of Judgment - Date of Judgment Absolute mo. day yr. Divorce or Annulment Docket Number Name of Plaintiff Cause for which Granted Signature of Certifying Official Title of Official 18a* 18b. .

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