Commonwealth of Massachusetts

Probate and Family Court Department

Docket No:

, Petitioner A
VS

, Petitioner B

Affidavit of Irretrievable Breakdown, pusuant to Mass. General Laws C. 208 Sec. 1A

We, and
Petitioner A Petitioner B

under oath do depose and say as follows:

1. We are the parties in the attached Joint Petition for Divorce.

2. We were married to one another on and last lived together on
Date of Marriage

at
Date last lived together Address last lived together at

3. We both believe that an irretrievable breakdown of the marriage has existed since our separation
and continues to exist at this time.

4. We both conclude that there is no chance of reconcilling our differences and returning to the state
of marriage which existed prior to our estrangement from each other.

5. We therefore wish that our marriage be terminated by divorce.

Signed and sworn to under the pains and penalties of perjury this day of

, 20

Petitioner A Petitioner B

c.g.f.