COUNSEL CERTIFICATION FORM 
Pursuant to SJC RULE 1:18

DOCKET NUMBER

Trial Court of Massachusetts

The Superior Court

CASE NAME:

VS

COURT NAME & ADDRESS

Clerk of Courts

County

I am attorney of record for

plaintiff

defendant in the above-entitled matter.

I hereby certify that in accordance with Rule 5 of the Supreme Judicial Court Uniform Rules on Dispute Resolution (SJC Rule  

1:18), I have complied with the requirements of the rule requiring that I provide my clients with information about court- 
  
connected dispute resolution services and discuss with them the advantages and disadvantages of the various methods of  

dispute resolution.

Dated:

Signature:

Print name:

Address:

BBO #:

rev: 01/10/2023



Uniform Counsel Form

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.

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About This Form:

• Sourced from www.mass.gov (2023-03)
• Page(s): 1
• Fields(s): 16
• Average fields per page: 16
• Reading Level: Grade 10
• LIST Grouping(s): CO-00-00-00-00, CO-07-00-00-00.

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