Massachusetts General Laws Part I. Administration of the Government (Ch. 1-182) Ch. 154, § 5

The standard form of assignment shall be as follows:

Know All Men by these Presents.

That I,     of    in the county of    , for a valuable consideration, to me paid by    , of    , the receipt whereof I do hereby acknowledge, do hereby assign and transfer to said    all claims and demands, not exempt by law (which I now have, and all) which within a period of    from the date hereof I may and shall have against my present employer, and against any person whose employ I shall hereafter enter, (for all sums of money due and) for all sums of money and demands which, at any time within said period may and shall become due to me, for services as    . To have and to hold the same to the said    , his executors, administrators and assigns, to secure a debt

IN WITNESS WHEREOF, I have set my hand this      day of    .

Signed and delivered, in presence of      h.    m.     M. Received and entered in records of assignment of wages in clerk's office of the     of    , book    , page    .