(Applicable to criminal cases)
The form for an application to waive indictment under the provisions of G.L. Chapter 263, § 4A shall be as follows:
COMMONWEALTH OF MASSACHUSETTS
APPLICATION TO WAIVE INDICTMENT
To the Honorable the Justices of the Superior Court:
Respectfully represents said defendant that on ___________, 20__, he was (committed) (bound over) (complained of) for trial in the Superior Court under the provisions of (G.L. c. 218 § 30 ) (G.L. c. 219 § 20 ) (St.1934 c. 358 ) by the (Court of ___________ ) (Hon. ______________, Trial Justice ___________) ( District Attorney for the ___________ District ) upon a complaint numbered ___________ of 20___ charging him with a crime not punishable by death; that he desires to waive indictment upon said charge and now applies for leave to waive such indictment and for prompt arraignment on such complaint.
I hereby consent to the foregoing application.
District Attorney for the _________ district.
Approved By the Court ___________ Clerk.