The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02

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Here is the text we could read:

AFFIDAVIT OF
PUBLIC ASSISTANCE

DOCKET NUMBER

Trial Court of Massachusetts
Juvenile Court Department

DIVISION

1.  I,                                                                      , plaintiff, hereby declare that I have made inquiry and, to the
     best of my knowledge, information and belief all of the information on this form is true, accurate and complete.

2.  The name(s) and address(es) of the child(ren) who is/are the subject of this complaint or petition are:

3.   a.    I am receiving public assistance.          Yes          No

      b.    I have received public assistance in the past.          Yes          No

             If the response is yes to either 3a or 3b, please specify the type of public assistance received:

      Department of Transitional Assistance (Public Welfare)

      Department of Children and Families

      Division of Medical Assistance (Medicaid)

      Other (Please specify):

4.  a.    The child(ren) listed above is/are receiving public assistance.          Yes          No

     b.    The child(ren) listed above received public assistance in the past.          Yes          No

             If the response is yes to either 4a or 4b, please specify the type of public assistance received:

                  Department of Transitional Assistance (Public Welfare)

      Department of Children and Families

      Division of Medical Assistance (Medicaid)

      Other (Please specify):

This affidavit must be personally signed by the plaintiff listed in Section 1.  If the plaintiff is under the age of 18
years and is represented by an attorney, the attorney must also sign this affidavit.  A revised affidavit must be filed
with the Court if new information is discovered subsequent to this filing.

Signed this                   day of                                                20             under the penality of perjury.

Signature:

Signature:

(Plaintiff)

(Attorney)

     Printed Name:

     Printed Name:

JV-024  (Rev. 04/20/2013)

Affidavit of Public Assistance

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Massachusetts state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.mass.gov (2023-03)
Page(s): 1
Fields(s): 36
Average fields per page: 36
Reading Level: Grade 8
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

transaction_page_set was transaction[0].#pageSet[0].Page1[0].UntitledSubform[0].Petitioner[0].TextField6[0] (0.59 conf)
transaction_set_text_field__1 was transaction[0].#pageSet[0].Page1[0].UntitledSubform[0].#subform[5].TextField6[0] (0.40 conf)
transaction_set_text_field__2 was transaction[0].#pageSet[0].Page1[0].UntitledSubform[0].TextField8[0] (0.40 conf)
transaction_set_text_field__3 was transaction[0].#pageSet[0].Page1[0].UntitledSubform[0].TextField8[1] (0.40 conf)
transaction_set_text_field__4 was transaction[0].#pageSet[0].Page1[0].UntitledSubform[0].TextField8[2] (0.40 conf)
transaction_page_case was transaction[0].Page1[0].case[0] (0.37 conf)
transaction_data_drop_list was transaction[0].Page1[0].DataDropDownList[0] (0.36 conf)
transaction_page_pet_name was transaction[0].Page1[0].Pet_Name[0] (0.42 conf)
transaction_page_text_field__1 was transaction[0].Page1[0].TextField6[0] (0.41 conf)
page_child_name_address__1 was transaction[0].Page1[0].Child_Name_Address[0].Child1_Name[0] (0.37 conf)
page_child_name_address__2 was transaction[0].Page1[0].Child_Name_Address[0].Child1_Address[0] (0.37 conf)
page_child_name_address__3 was transaction[0].Page1[0].Child_Name_Address[0].Child2_Name[0] (0.37 conf)
page_child_name_address__4 was transaction[0].Page1[0].Child_Name_Address[0].Child2_Address[0] (0.37 conf)
page_child_name_address__5 was transaction[0].Page1[0].Child_Name_Address[0].Child3_Name[0] (0.37 conf)
page_child_name_address__6 was transaction[0].Page1[0].Child_Name_Address[0].Child3_Address[0] (0.37 conf)
page_child_name_address__7 was transaction[0].Page1[0].Child_Name_Address[0].Child4_Name[0] (0.37 conf)
page_child_name_address__8 was transaction[0].Page1[0].Child_Name_Address[0].Child4_Address[0] (0.37 conf)
transaction_page_check_box__1 was transaction[0].Page1[0].#subform[1].CheckBox1[0] (0.38 conf)
transaction_page_check_box__2 was transaction[0].Page1[0].#subform[1].CheckBox1[1] (0.38 conf)
transaction_page_check_box__3 was transaction[0].Page1[0].#subform[2].CheckBox1[2] (0.38 conf)
transaction_page_check_box__4 was transaction[0].Page1[0].#subform[2].CheckBox1[3] (0.38 conf)
transaction_page_check_box__5 was transaction[0].Page1[0].#subform[3].CheckBox1[4] (0.38 conf)
transaction_page_check_box__6 was transaction[0].Page1[0].#subform[3].CheckBox1[5] (0.38 conf)
transaction_page_check_box__7 was transaction[0].Page1[0].#subform[3].CheckBox1[6] (0.38 conf)
transaction_page_check_box__8 was transaction[0].Page1[0].#subform[3].CheckBox1[7] (0.38 conf)
transaction_page_text_field__2 was transaction[0].Page1[0].#subform[3].TextField7[0] (0.41 conf)
transaction_page_check_box__9 was transaction[0].Page1[0].#subform[4].CheckBox1[8] (0.38 conf)
transaction_page_check_box__10 was transaction[0].Page1[0].#subform[4].CheckBox1[9] (0.38 conf)
transaction_page_check_box__11 was transaction[0].Page1[0].#subform[5].CheckBox1[10] (0.38 conf)
transaction_page_check_box__12 was transaction[0].Page1[0].#subform[5].CheckBox1[11] (0.38 conf)
transaction_page_check_box__13 was transaction[0].Page1[0].#subform[6].CheckBox1[12] (0.38 conf)
transaction_page_check_box__14 was transaction[0].Page1[0].#subform[6].CheckBox1[13] (0.38 conf)
transaction_page_check_box__15 was transaction[0].Page1[0].#subform[6].CheckBox1[14] (0.38 conf)
transaction_page_check_box__16 was transaction[0].Page1[0].#subform[6].CheckBox1[15] (0.38 conf)
transaction_page_text_field__3 was transaction[0].Page1[0].#subform[6].TextField7[1] (0.41 conf)
transaction_page_text_field__4 was transaction[0].Page1[0].TextField6[1] (0.41 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Affidavit of Public Assistance

About This Form:

Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02