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					Petitioner:

To complete this affidavit, please fill in the appropriate blanks with your name, address, and the
approximate number of inmate calls you receive. Then please identify the facilities from which you
received calls. A check mark next to the name(s) will do the trick. It is not necessary that you check off
every facility from which you receive calls. However, if you have spoken to prisoners at both state and
county facilities, please identify at least one state and one county facility on the list.

In addition to stating that the cost of calls is too high, the affidavit also states that the phone service is
poor. A number of people are having problems with bad reception, dropped calls, and excessive playing
of recorded messages. If you are NOT troubled by the quality of calls from prisoners, please simply
delete this line or black it out.

Please sign and date the form and mail it to me:

Dana Goldblatt
Prisoners' Legal Services
Eight Winter Street, 11th Floor
Boston, MA 02108


If you prefer an affidavit with your information already filled in (one ready to print, sign, and send)
please contact me at 203-500-0666 or by email at dana.goldblatt@gmail.com. I would be more than
happy to customize an affidavit for you.

I look forward to working with you.

Dana
                                          AFFIDAVIT

I, _____________________________, do hereby affirm as follows:

   1. I am a lawyer duly licensed to practice law in the Commonwealth of Massachusetts. My
mailing address is _____________________________________________________________.
    2. I represent and receive telephone calls from clients who are incarcerated in correctional
facilities in the Commonwealth.
    3. The facilities from which I have received telephone calls in the past include those
identified with a check or similar mark on the attached list.
   4. On average, I receive approximately______________________________ calls per
day/week/month/year from prisoners of correctional facilities in the Commonwealth.
   5. I pay the phone company or its agent or affiliate for the above-described calls.
    6. The cost of the above-described calls is very high, and I am petitioning the Department of
Telecommunications (the “DTC”) because I want the DTC to lower the rates I pay to receive
calls from incarcerated clients.
    7. The quality of the above-described calls is poor, and I also want the DTC to take some
action to improve the quality of those calls.


   Signed under the penalties of perjury this _____ day of ________, 2011.




                                                            _____________________________
COUNTY FACILITIES

_____ Barnstable Jail and House of Correction   _____ Hampshire County Jail and House of
      6000 Sheriff’s Place                            Correction
      Bourne, MA 02532                                205 Rock Hill Road, P.O. Box 7000
                                                      Northampton, MA 01060-7000
_____ Berkshire County Jail and House of
      Correction                                _____ Middlesex County Jail (Cambridge)
      467 Cheshire Road                               40 Thorndike Street
      Pittsfield, MA 01201                            P.O. Box 97
                                                      East Cambridge, MA 02141
_____ Bristol County Jail and House of
      Correction (North Dartmouth)              _____ Middlesex County House of Correction
      400 Faunce Corner Road                          (Billerica)
      North Dartmouth, MA 02747                       269 Treble Cove Road
                                                      P.O. Box 565
_____ Bristol County Jail and House of                Billerica, MA 01821
      Correction (Ash Street)
      266 Ash Street                            _____ Norfolk County Correctional Center
      New Bedford, MA 02740                           200 West Street
                                                      P.O. Box 149
_____ Bristol County Women’s Center                   Dedham, MA 02027
      400 Faunce Corner Road
      North Dartmouth, MA 02747                 _____ Plymouth County Correctional Facility
                                                      Jail and House of Correction
_____ Dukes County Jail and House of                  26 Long Pond Road
      Correction                                      Plymouth, MA 02360
      149 Main Street
      P.O, Box 252                              _____ Nashua Street Jail
      Edgartown, MA 02539                             200 Nashua Street
                                                      Boston, MA 02114
_____ Essex County Jail and House of
      Correction                                _____ Suffolk County House of Correction
      20 Manning Avenue                               20 Bradston Street
      P.O. Box 807                                    Boston, MA 02118
      Middleton, MA 01949-2807
                                                _____ Western Massachusetts Correctional
_____ Women in Transition Program                     Alcohol Center
      Maris House                                     26 Howard Street
      197 Elm Street                                  Springfield, MA 01013
      Salisbury, MA 01952
                                                _____ Western Massachusetts Regional
_____ Franklin County Sheriff’s Office                Women’s Correctional Center
      160 Elm Street                                  701 Center Street
      Greenfield, MA 01301                            Chicopee, MA 01013

_____ Hampden County Jail and House of          _____ Worcester County Jail and House of
      Correction and Correctional Center @            Correction
      Stony Brook                                     5 Paul X. Tivnan Drive
      627 Randall Road                                West Boylston, MA 01583
      Ludlow, MA 01056
STATE FACILITIES

_____ Boston Pre-Release                      _____ MCI-Plymouth
      430 Canterbury Street                         Myles Standish Forest
      Roslindale, MA 02131                          PO Box 207
                                                    South Carver, MA 02366
_____ Bay State Correctional Center
      28 Clark Street                         _____ MCI-Shirley
      PO Box 73                                     PO Box 1218
      Norfolk, MA 02056                             Shirley, MA 01464

_____ Bridgewater State Hospital              _____ North Central Correctional Institution
      20 Administration Road                        (Gardner)
      Bridgewater, MA 02324                         500 Colony Road
                                                    PO Box 466
_____ Lemuel Shattuck Hospital Correctional         Gardner, MA 01440
      Unit
      180 Morton Street                       _____ Northeastern Correctional Center
      Jamaica Plain, MA 02130                       (Concord Farm)
                                                    Barretts Mill Road
_____ Massachusetts Alcohol and Substance           PO Box 1069
      Abuse Center                                  West Concord, MA 01742
      2 Administration Road
      Bridgewater, MA 02324                   _____ Old Colony Correctional Center
                                                    One Administration Road
_____ Massachusetts Treatment Center                Bridgewater, MA 02324
      30 Administration Road
      Bridgewater, MA 02324                   _____ Pondville Correctional Center
                                                    PO Box 146
_____ MCI-Cedar Junction at Walpole                 Norfolk, MA 02056
      Route 1A
      P.O. Box 100                            _____ South Middlesex Correctional Center
      South Walpole, MA 02071                       135 Western Avenue
                                                    PO Box 788
_____ MCI-Concord                                   Framingham, MA 01701
      965 Elm Street
      PO Box 9106                             _____ Souza-Baranowski Correctional Center
      Concord, MA 01742                             PO Box 8000
                                                    Shirley, MA. 01464
_____ MCI-Framingham
      99 Loring Drive                         _____ Western Massachusetts Regional
      PO Box 9007                                   Women’s Correctional Center
      Framingham, MA 01704                          701 Center Street
                                                    Chicopee, MA 01013
_____ MCI-Norfolk
      2 Clark Street
      PO Box 43
      Norfolk, MA 02056

				
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