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41-009 (13) I HAVE ATTEMPTED TO RESOLVE THIS PROBLEM BY DOING THE FOLLOWING: 6,AAS I vd, Alm c� THEREFORE I AM ASKING THq-CPURT TO: Lwy ban f et Le d -r V l c � f S 4ED DATE i PLEASE PRINT AFFIDAVIT PLEASE PRINT THIS IS A REQUEST FOR AN EMERGENCY ORDER UNDER THE PAINS AND PENALTIES OF PERJURY I SWEAR AND AFFIRM THAT: MY NAME IS I Am The: ,g �n5p.���o� o.n or►.' �. -,� D °,My Business Address is: 0 M ; IA 6 vef o Telephone # MA 0 /06 1 AM BRINGING THIS ACTION AGAINST: D"yj who resides at / e5a onity� Zip d 0 Phone v lee r.,Aq, THIS ACTION RELATES TO PROPERTY LOCATED AT: 010LO (Explain the Defendant's relationship to the property): M Owner [ ] Tenant [ ] Neighbor [ ]Visitor [ ] Other : On M, 028 , The Following Occurred: (PRINT) - — �►� e,Sfi �c.5 .e.d' a o• G � G r /SeS� Ion'? r ve G 4,5 C a,wo D iv►d d/5 G:.r, /)Of a.l(o w e cQ � a,.S .era. i6 no rvw-, S G.r rt vK ;11 L `D-A � (OVER) PROOF OF SERVICE OF PROCESS I hereby certify and return that on 200 1 served a copy of the within summons and restraining orders, togetherwith a copy of the complaint in this action, upon the within named defendant, in the following manner [See Mass. R.Civ.P.4(d)(1-5)j: Dated: , 200_. Print Name Signature N.B. TO PROCESS SERVER: PLEASE PLACE THE DATE YOU MAKE SERVICE ON THE DEFENDANT IN THIS BOX ON THE ORIGINAL AND ON COPY SERVED ON DEFENDANT. ( , 200 ) sir C Gy COMMONWEALTH OF MASSACHUSETTS = THE TRIAL COURT _ b HOUSING COURT DEPARTMENT WESTERN DIVISION 37 ELM STREET - P.O. BOX 559 SPRINGFIELD, MA 01 102-0559 TELEPHONE (413) 748-7838 FAX (413) 732-4607 DINA E. FEIN PETER Q. MONTORI FIRST JUSTICE CLERK MAGISTRATE ROBERT G. FIELDS KEVIN R. BYRNE, SR. ASSOCIATE JUSTICE CHIEF HOUSING SPECIALIST Case No. (� ��1 ( Date: i Plaintiff s) �y Def ndant(s),, Street Street City/Zip City/Zip APPLICATION FOR TEMPORARY RESTRAINING ORDER Based upon the specific facts set out in the attached affidavit/verified complaint filed with the Clerk of this Court, I request that the Court order the above Defendant(s) to desist and refrain from D �e LPS-/- D l end � 1<�''d/cep✓o�� I also request the Court waive Rule 65(c)of MRCP that I provide security for the issuance of the above orders because Signed and sworn to under penalties of perjury this before Clerk-Magistrate. Signature NOTICE OF HEARING ON TEMPORARY RESTRAINING ORDER TO THE DEFENDANT: You are hereby notified that a hearing on the above application will be held at the West rn Divjjsion of Th Housing Court,sitting in 116 Russell St. (Rte 9) HADLEY, MA,on MONDAY at 9:00 a.m. at which you may appear and show cause why such app Ic tion sh uld not/be granted. WITNESS: Dina E. Fein, Esq. at Northampton