The Commonwealth of Massachusetts

S U F F O L K , s s .                                                                            T R I A L C O U R T O F T H E C O M M O N W E A L T H
B O S T O N M U N I C I P A L C O U R T D E P A R T M E N T

Plaintiff(s)

Defendant(s)

C i v i l A c t i o n N o .

CERTIFICATION OF COMPLIANCE WITH RULE 5 OF THE 
SJC UNIFORM RULES ON DISPUTE RESOLUTION.

I am attorney of record for:  

G  Plaintiff   G  Defendant   G  Other (specify)
In accordance with Rule 5 of the Supreme Judicial Court Uniform Rules on Dispute Resolution (SJC Rule

in the above captioned action.

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
action cover sheet or it’s equivalent...,”  I hereby certify that I have complied with this requirement.

Signed

Print or Type Name

B.B.O. Number

Date

T h is c e rtific a tio n  m a y  b e  file d  b y  c o u n s e l a s  is , o r th is  tex t m a y  b e  in c o rp o ra te d  in to  a  fo rm  c u rre n tly  in  u s e a t th e

in itia tio n   o f  a   c a s e   (e .g .,  civ il  c o v er  s h e e t,  a p p e a r a n c e   fo rm ,  e tc .),  a s   d e term in e d   to   be  a p p ro p ria te   in   e a c h

d e p a rtm e n t  o f  th e   T ria l  C o u rt.  P la in tiff/ P e titio n e r’s   c o u n s e l  s h a ll  fil e   th is   d o c u m e n t  a t  th e   tim e   h is / h e r  in itia l
p l e a d i n g  i s  f i l e d . A  l l o t h e r  c o u n s e l s h a l l f i l e  i t  w  i t h i n  t h i r t y  ( 30  )  d a y s  o f  h i s / h e r  i n i t i a l e n t r y  i n t o  t h e  c a s e  w  h e t h e r
b y  a n s w e r, m o tio n , a p p e a ra n c e  s lip  o r o th e r p le a d in g .

B M C - C V - 0 4 4 

C O U N S E L C E R T I F I C A T I O N                                            (Rev. 02/99  s w f)