Mass. Gen. Laws ch. 277 § 79
The provisions of this chapter, and the forms hereto annexed, shall apply as well to complaints as to indictments, and such forms shall be sufficient in cases to which they are applicable. In other cases, forms as nearly like the forms hereto annexed as the nature of the cases and the provisions of law will allow may be used; but any other form of indictment or complaint authorized by law may be used.
(Suffolk,) to wit:
At the Superior Court holden at (Boston,) within and for the County of (Suffolk,) for the transaction of criminal business, on the ________ day of ________ in the year of our Lord one thousand, etc.
The jurors for the said Commonwealth on their oath present
(Suffolk,) to wit:
To the ________ court of ________ holden at ________ for the transaction of criminal business, within the County of ________, A. B. of ________ in behalf of the Commonwealth of Massachusetts on the ________ day of ________ in the year ________, on oath complains that
To A. B., a Trial Justice in and for the County of ________ and Commonwealth of Massachusetts, C.D. of ________(etc. as in form above)
To A. B., Justice of the Peace in and for the County of ________ and Commonwealth of Massachusetts, designated and commissioned to issue warrants in criminal cases, C. D. of ________(etc. as in form above)
(If the statute requires a particular person to make complaint, this should be alleged.)
Abduction. (Under Chap. 272, Secs. 1, 2.)
(1) That A. B. did fraudulently and deceitfully entice (and take away) one C. D., an unmarried person under the age of sixteen years, from the house of the father (or guardian, etc., as the case may be), without the consent of the said father (or guardian, etc., as the case may be), under whose care and custody said C. D. was living, for the purpose of effecting a clandestine marriage of said C. D. without the consent of said father (or guardian, etc., as the case may be).
(2) That A. B. did fraudulently and deceitfully entice (and take away) C. D. from his house (or, if a minor, from his father's or guardian's house; or if elsewhere, state it as the case may be), for the unlawful purpose of prostitution (or for the purpose of unlawful sexual intercourse).
Abortion. (Under Chap. 272, Sec. 19.) (1) That A. B., with intent to procure the miscarriage of C. D., did unlawfully administer to her (or advise, or prescribe for her, or cause to be taken by her) a certain drug (or medicine or other noxious thing, as the case may be).
If the woman dies, add "and in consequence thereof said C. D. died". (2) That A. B., with intent to procure the miscarriage of C. D., did unlawfully use a certain instrument upon the body of said C. D., and in consequence thereof said C. D. died.
(3) That A. B., with intent to procure the miscarriage of C. D., did unlawfully do certain things (naming them) to (or upon the body of) said C. D.
Accessory before the fact. (Under Chap. 274, Sec. 2.) Charge principal felony and proceed: That A. B., before the said felony was committed, did incite, procure, aid, counsel, hire or command the said (principal) the said felony to do and commit.
Accessory after the fact. (Under Chap. 274, Sec. 4.) Charge principal felony and proceed: That A. B. afterwards, well knowing the said C. D. to have committed the felony aforesaid, did harbor, (conceal, maintain,) or assist said C. D., with intent that said C. D. should avoid or escape (detention, arrest,) trial, or punishment.
Adultery. (Under Chap. 272, Sec. 14.) (1) That A. B., a married person, did commit adultery with C. D., a person not his spouse.
(2) That A. B., an unmarried person, did commit adultery with C. D., a married person.
Affray. That A. B. and C. D. did make an affray.
Aggravated rape. (Under Chap. 265 Sec. 22(a).) That A.B. did assault C.D., with intent to commit aggravated rape; and did commit aggravated rape upon said C.D.
Alcoholic beverages. (Under Chap. 138, Sec. 2.) That A. C. did expose and keep for sale alcoholic beverages, as defined in section one of chapter one hundred and thirty-eight, with intent unlawfully to sell the same.
Alcoholic beverages Sale. (Under Chap. 138, Sec. 2.) That A. B. unlawfully did sell alcoholic beverages, as defined in section one of chapter one hundred and thirty-eight, to C. C.
Alcoholic beverages Nuisance. (Under Chap. 139, Sec. 15.) That A. B., during the three months next before the finding of this indictment, without legal authority, did keep and maintain a certain tenement in said (Boston), by him used for the illegal sale and illegal keeping for sale of alcoholic beverages, as defined in section one of chapter one hundred and thirty-eight, to the common nuisance of all the people.
Armed with dangerous weapon when arrested. (Under Chap. 269, Sec. 9.) (1) That A. B., while being lawfully arrested on a sufficient warrant on a criminal charge, was armed with a dangerous weapon, to wit, a slung shot (or other dangerous weapon, as the case may be).
(2) That A. B., while committing the crime of (here state crime), was lawfully arrested by C. D., sheriff of said county, and when so arrested was armed with, and had on his person, a certain dangerous weapon (a slung shot, etc., as the case may be).
Arson. (Under Chap. 266, Secs. 1, 2, 4.) (1) That A. B. wilfully and maliciously did burn the dwelling house of C. D. in ________ in said county.
(2) That A. B. wilfully and maliciously did burn a building adjoining the dwelling house of C. D. in ________ in said county.
(3) That A. B. wilfully and maliciously did set fire to a building in ________ by the burning whereof the dwelling house of C. D. was burned.
(4) That A. B. wilfully and maliciously, in the night time, did burn
(a) A meeting house (or church, town house, etc.) in ________ in said county, erected for public use.
(b) A banking house (or warehouse, etc.) of C. D. in ________ in said county, of the value, with the property therein, of one thousand dollars and not the property of (the defendant). (c) A barn (or stable or shop or office) of C. D., in ________ in said county, the same being there within the curtilage of the dwelling house of said C. D.
(5) That A. B. wilfully and maliciously did burn a building, by the burning whereof [(a), (b), or (c)] was burned in the night time.
(6) That A. B. wilfully and maliciously did burn a banking house (or other structure mentioned in the statute, as the case may be) of C. D., in ________ in said county.
Assault and battery. That A. B. did assault and beat C. D.
Assault to maim, etc. (Under Chap. 265, Sec. 15.) That A. B. did assault C. D., with the malicious intent to maim (or disfigure) said C. D. by cutting out his tongue (or other facts required by the nature of the case).
Assault to murder. (Under Chap. 265, Sec. 15.) That A. B. did assault C. D., with intent to murder him.
Assault to Rape. (Under Chap. 265, Sec. 24.) (1) That A. B. did assault C. D., with intent to commit rape.
(2) That A. B. did assault C. D., a child under the age of sixteen years, with intent unlawfully and carnally to know and abuse.
Assault with dangerous weapon, with intent to rob, etc. (Under Chap. 265, Sec. 18.) That A. B., being armed with a dangerous weapon, did assault C. D., with intent to rob him (or to murder him).
Assault upon an officer. That A. B. did assault and beat C. D., who was a police officer of the (city of Boston) (or whatever the fact may be), and who was also in the lawful discharge of his duties as such officer, as said (defendant) well knew, (and knowingly resisted and obstructed him in the discharge of his lawful duties). This clause may be added if facts require.
Assuming to be an officer. (Under Chap. 268, Sec. 33.) That A. B. did falsely assume and pretend to one C. D. that he, said A. B., was a police officer of (the city of ________) (or a constable of the city of ________), and did take upon himself to act as such officer, and did (state what he did if desired).
Attempt to break and enter. (Under Chap. 274, Sec. 6.) That A. B. did attempt to break and enter a certain building in said (Boston) of one C. D., in the (night) time, with intent therein to commit larceny, and in such attempt did (set out the overt act relied on); but did fail in the perpetration of said attempted offence (or was intercepted and prevented in the execution of said attempted offence).
Attempt to commit crime. (Under Chap. 274, Sec. 6.) That A. B. did attempt to commit larceny of the property of (another), (or such other crime as may be intended to be charged), and in such attempt did (set out the overt act relied on); but did fail in the perpetration of said attempted offence (or was intercepted and prevented in the execution of said attempted offence).
Attempt to steal from person. (Under Chap. 274, Sec. 6.) That A. B. did attempt to steal from the person of C. D., and in such attempt did put his hand against the person and into the pocket of the said C. D.; but did fail in the perpetration of said attempted offence (or was intercepted and prevented in the execution of said attempted offence).
Breaking, entering, etc. (Under Chap. 266, Secs. 16-19.) (1) That A. B. did break and enter in the night time the building (or ship or vessel) of one X., situated in said (Boston), with intent therein to commit murder (or rape, robbery, etc.).
(2) That A. B. did break and enter (or entered in the night time without breaking) a building (or ship or vessel) of one X., in said (Boston), with intent (as above), the said X. (or other person), who was lawfully therein, being put in fear.
(3) That A. B. did break and enter (or entered in the night time without breaking) a railroad car situated in said (Boston), of the (name of the railroad), with intent therein to commit larceny (or murder, etc., as the case may be).
(4) That A. B. did enter in the night time the dwelling house of one X., in said (Boston), with intent therein to commit larceny (or murder, etc., as the case may be).
(5) That A. B. did break and enter a building (or ship or vessel) of one X., in said (Boston), with intent therein (etc. as above).
Breaking glass. (Under Chap. 266, Sec. 114.) That A. B. did wantonly (or maliciously) break certain panes of glass in and part of a certain building, the property of C. D. in said (Boston).
Burglarious implements. (Under Chap. 266, Sec. 49.) That A. B. knowingly did have in his possession certain machines, tools and implements adapted and designed for cutting through, forcing and breaking open buildings, rooms, vaults, safes (and other depositories), in order to steal therefrom such money and other property as might be found therein, said A. B. knowing said machines, tools and implements to be adapted and designed for the purpose aforesaid, and intending to use and employ them therefor.
Burglary, etc. (Under Chap. 266, Secs. 14, 15.) (1) That A. B. in the night time did break and enter the dwelling house of C. D., situated in said (Boston), with intent therein to commit larceny (or murder, rape or robbery, as the case may be).
If desired add actual larceny in the building.
(2) That A. B. did enter the dwelling house of one X., situated in said (Boston), with intent therein to commit larceny, and after having so entered with said intent did break said dwelling house in the night time, X. being lawfully therein, and said A. B. being armed with a dangerous weapon at the time of such entry (or such breaking) (or arming himself with a dangerous weapon in said house) (or did make an assault on said X., who was lawfully therein).
(3) That A. B. did break and enter the dwelling house of one X., in said (Boston), in the night time, with intent therein to commit larceny (or murder, etc., as the case may be).
Burning to defraud insurance company. (Under Chap. 266, Sec. 10.) That A. B. did burn a certain building in ________ in said county, [or certain goods, wares and merchandise (or other chattels name the property)] which was (or were) at the time of such burning insured in the ________ Insurance Company, a corporation duly established by law, against loss or damage by fire, with the intent thereby to injure the said insurer.
Common drunkard. (Under Chap. 272, Sec. 53.) That A. B., during the three months next before the making of this complaint, was a common drunkard.
Common nightwalker. (Under Chap. 272, Sec. 53.) That A. B., during the three months next before the making of this complaint, was a common nightwalker, habitually walking in the streets in the night time for the purpose of prostitution.
Concealing mortgaged personal property. (Under Chap. 266, Sec. 82.) That A. B. did mortgage to X. in due form of law certain personal property (setting out the mortgaged property), and that afterward, the said mortgage being in full force and effect, and the said X. remaining the owner thereof (if such be the fact), said A. B. did remove and conceal the said property with fraudulent intent to place the same beyond the control of the said X.
Conspiracy. (1) That A. B. and C. D. conspired together to murder one E. F.
(2) That A. B. and C. D. conspired together to commit rape upon E. F.
(3) That A. B. and C. D. conspired together to steal the property, money, etc., of E. F.
Cruelty to animals. (Under Chap. 272, Sec. 77.) (1) That A. B. did overdrive (overload) (drive when overloaded) (overwork) (torture) (torment) (deprive of necessary sustenance) (cruelly beat) (cruelly mutilate) (cruelly kill) a certain horse (or dog, etc.).
(2) That A. B. did cause and procure one C. D. to overdrive (etc.) a certain horse (etc.).
(3) That A. B., having the charge and custody of a certain horse (etc.), did inflict unnecessary cruelty upon it.
(4) That A. B., having the charge and custody of a certain horse (etc.), did unnecessarily fail to provide it with proper food (or drink or shelter or protection from the weather).
Disorderly house. (Under Chap. 219, Sec. 27.) That A. B., during the three months next before the finding of this indictment, at said (Boston) did keep and maintain a certain and common, noisy, ill-governed and disorderly house, resorted to for the purpose of drinking, quarrelling, making great noises, and breaking and disturbing the peace, to the common nuisance of all the people.
Drunkenness. (Under Chap. 272, Sec. 48.) That A. B. was, by the voluntary use of intoxicating liquor, drunk.
Eavesdropping. (Under Chap. 272, Sec. 99.) That A. B. did commit the crime of eavesdropping.
Escape. (Under Chap. 268, Sec. 16.) That A. B., being lawfully imprisoned in the House of Correction (or the Massachusetts correctional institution) in said county, did break therefrom and escape.
Exposure of person. That A. B., in a public place in said (Boston), wherein were great numbers of people, indecently did expose to the view of the said people his body and person naked and uncovered.
Forged endorsement. That A. B. did forge a certain endorsement in and upon the back of, and as a part of, a certain promissory note, with intent to injure and defraud. (The purport or substance of the note and endorsement may be set forth.
Forgery. (Under Chap. 267, Sec. 1.) That A. B., with intent to injure and defraud, did forge a certain instrument purporting to be, etc. (give the name of the instrument, description, tenor or substance as the pleader chooses).
Fornication. (Under Chap. 272, Sec. 18.) That A. B., an unmarried person, did commit fornication with C. D., an unmarried person.
Gaming. (Under Chap. 139, Sec. 15.) That A. B., during the three months next before the finding of this indictment, at said (Boston), did keep and maintain a certain common nuisance, to wit, a tenement resorted to and used for illegal gaming.
House of ill fame. (Under Chap. 272, Sec. 24.) That A. B., during the three months next before the finding of this indictment, did keep at said (Boston) a certain house of ill fame, resorted to for purposes of prostitution and lewdness.
House of ill fame Nuisance. (Under Chap. 139, Sec. 15.) That A. B., during the three months next before the finding of this indictment, at said (Boston), did keep and maintain a certain tenement used for prostitution, assignation and lewdness (or in which acts of prostitution, assignation and lewdness occurred), to the common nuisance of all the people.
Idle and disorderly person. (Under Chap. 272, Sec. 53.) That A. B., during the three months next before the making of this complaint, was an idle and disorderly person, and neglected all lawful business and habitually misspent his time by frequenting houses of ill fame, gaming houses or tippling shops.
Incest. (Under Chap. 272, Sec. 17.) That A. B., being the father of C. D. (or state such relationship as will show the parties to be within the degree of consanguinity within which marriages are prohibited or declared by law to be incestuous and void), did have carnal knowledge of the body of said C. D.
(A. B. being married to another woman than said C. D., if such be the fact, and it be desired to cover adultery.
Larceny. (Under Chap. 266, Sec. 30.) (1) That A. B. did steal one horse of the value of more (or less, as the case may be) than one hundred dollars, of the property of C. D.
(2) That A. B. did steal six cows, each of the value of twenty dollars, of the property of C. D.
Larceny from a conveyance. (Under Chap. 266, Sec. 30.) That A. B. did steal from a certain conveyance, to wit, the wagon of one C. D., one book of the value, etc., of the property of C. D., the said C. D. being a common carrier (or a person carrying on the express business), and said conveyance being used by the said C. D. in said business.
Larceny from realty. (Under Chap. 266, Sec. 44.) That A. B., by a trespass, with intent to steal, did take and carry away from the realty, to wit, from the building of C. D., in said (Boston), ten pounds of lead pipe, each of the value of (etc.), of the property of C. D., against his will, the said lead pipe being annexed to and a part of said building.
Larceny in building. (Under Chap. 266, Sec. 20.) That A. B. did steal (one coat of the value of more than ________ or less than ________), of the property of X., in a certain building (or ship or vessel or railroad car) of the said X., situated in said (Boston).
Larceny of beast or bird. (Under Chap. 266, Sec. 46.) That A. B. did steal a certain domesticated animal (or bird which was ordinarily kept in confinement), which was the property of C. D.
Lewd and lascivious cohabitation. (Under Chap. 272, Sec. 16). That A. B. and C. D., not being married to each other, did during one month next before the finding of this indictment (or such time as the evidence requires), lewdly and lasciviously associate and cohabit together.
Lewdness. (Under Chap. 272, Sec. 53.) That A. B., during the three months next before the finding of this indictment, was a lewd, wanton and lascivious person in speech and behavior.
Lord's Day. (Under Chap. 136, Sec. 5.) That A. B., on the ________day of ________, in the year of our Lord one thousand, etc., that day being the Lord's Day, did keep open his shop in said (Boston), for the purpose of doing business therein (or did labor or business or work), the same not being a work of necessity or charity.
Lottery. (Under Chap. 271, Sec. 7.) (1) That A. B. did set up and promote a lottery for money.
(2) That A. B. was concerned in the setting up (or managing or drawing) of a certain lottery for money.
(3) That A. B. did dispose of a certain horse of the value of ten dollars to C. D., by way of a lottery.
(4) That A. B., under the pretext of the sale of certain property, to wit: (state the property) to C. D., did dispose of to said C. D. certain other personal property, to wit: (state the property), with intent of said A. B. to make the said disposal of said (property) dependent upon a chance by lot, and that such chance was made an additional inducement to the disposal and sale of said (property).
Maiming, etc. (Under Chap. 265, Sec. 14.) That A. B. did assault C. D., and, with malicious intent to maim and disfigure said C. D., did cut out his tongue.
Malicious injury. (Under Chap. 266, Sec. 127.) That A. B. did wilfully and maliciously injure (or destroy) certain personal property (name it and allege value) of C. D.
Malicious injury to real property. (Under Chap. 266, Sec. 104.) That A. B. did wilfully (or maliciously) destroy (or deface or mar) a certain building of C. D. in said (Boston).
Manslaughter. (Under Chap. 265, Sec. 13.) That A. B. did assault and beat C. D., and by such assault and beating did kill C. D.
Manslaughter by negligence. That A. B., being under the legal duty, and being of sufficient ability to provide C. D., who was his spouse, with sufficient food and drink for sustenance and maintenance, did neglect and refuse so to do; by reason whereof said C. D., being unable to provide sufficient food and drink, became and was mortally sick and died.
Murder. (Under Chap. 265, Sec. 1.) That A. B. did assault and beat C. D., with intent to murder him (by striking him over the head with an axe), and by such assault and beating did (kill and) murder C. D. (and the jurors further say that the defendant is guilty of murder in the second degree and not in the first degree). This may be added if murder in the first degree is not alleged.
Neglect of Spouse or Minor Child. (Under Chap. 273, Sec. 1.) That A. B., during the three months next before the making of this complaint, being of sufficient ability, did unreasonably neglect to provide for the support of C. D., his lawful spouse (and E. D., his minor child).
Obtaining signature by false pretences. (Under Chap. 266, Sec. 31.) That A. B. designedly and with intent to defraud did falsely pretend to C. D. that, etc., and by means of said false pretences, which said C. D. believed and relied upon, did obtain the signature of said C. D. to a certain written instrument, the false making whereof would be punishable as forgery, to wit, a certain promissory note (describe as in forgery); that the pretences so made to C. D. were false and were known to be false by the said A. B. at the time when he so made them.
Open and gross lewdness. (Under Chap. 272, Sec. 16.) That A. B. was guilty of open and gross lewdness and lascivious behavior in the presence of C. D.
Prostitute. (Under Chap. 272, Sec. 53.) That A. B. was a prostitute, offering his or her body indiscriminately to others for hire.
Perjury. (Under Chap. 268, Sec. 1.) That in a proceeding in the course of justice before the (set forth the tribunal), on an issue within the jurisdiction of said court duly joined, and tried before a jury of the county between X. as plaintiff and Y. as defendant, A. B. was lawfully sworn as a witness.
Whereupon it became and was material to said issue whether (say what), and to this the said A. B. did wilfully and corruptly testify and say in substance and effect that (say what); all his said testimony as above set forth being false, as he well knew.
Polygamy. (Under Chap. 272, Sec. 15.) (1) That A. B. unlawfully married C. D., the said A. B. having at the time he so unlawfully married a lawful spouse living other than said C. D.
(2) That A. B., having a lawful spouse living, to wit: X., did at (state place) unlawfully marry and have for his spouse one C. D., after which the said A. B. did, while said X., was still living, on, at, etc., unlawfully cohabit and continue to cohabit in (Boston) with the said C. D.
Rape. (Under Chap. 265 Secs. 22(b), 23.) (1) That A. B. did assault C. D. with the intent to commit rape; and did commit rape upon said C. D.
(2) That A. B. did assault C. D., a child under the age of sixteen years, with the intent to unlawfully have sexual intercourse or unnatural sexual intercourse with and abuse said C. D.; and did unlawfully have sexual intercourse or unnatural sexual intercourse with and abuse said C. D.
Receiving stolen property. (Under Chap. 266, Sec. 60.) That A. B., one watch of the value ________ dollars, the property of one C. D., then lately before stolen, did buy, receive, and aid in the concealment of, the said A. B. well knowing the said property to have been stolen as aforesaid.
Rescue. (Under Chap. 268, Sec. 15.) That A. B. did forcibly rescue and take out of the lawful custody of E. F. one C. D., the said C. D. being a prisoner arrested by and held in the lawful custody of E. F., upon the charge of the crime of (larceny), the said E. F. being a police officer of (said city), duly authorized to arrest and hold in custody the said C. D. upon the charge aforesaid.
Robbery. (Under Chap. 265, Sec. 19.) That A. B. did assault C. D. with intent to rob him, and thereby did rob and steal from the person of said C. D. (mention the property) of the property of said C. D.
Sodomy, etc. (Under Chap. 272, Sec. 34.) That A. B. did commit the abominable and detestable crime against nature with a (state the person or beast).
Stubborn child. (Under Chap. 272, Sec. 53.) That A. B., a minor, during the three months next before the making of this complaint, was a stubborn child, and stubbornly refused to submit to the lawful and reasonable commands of C. D., whose commands said A. B. was bound to obey.
Threats to extort. (Under Chap. 265, Sec. 25.) That A. B. did verbally (or by a written or printed communication) maliciously threaten one C. D., to accuse him of the crime of (name it), with the intent thereby to extort money from the said C. D.
Unlawful appropriation. (Under Chap. 266, Sec. 63.) That A. B. did wilfully, mischievously and without right take, drive and use a certain horse, the property of one C. D., without the consent of the said owner of said horse, or any person having the legal custody, care or control of the same.
Unnatural act. (Under Chap. 272, Sec. 35.) That A. B. did commit an unnatural and lascivious act with one C. D.
Uttering. (Under Chap. 267, Sec. 5.) That A. B., with intent to injure and defraud, did utter and publish as true a certain forged instrument (describe as in forgery), well knowing the same to be forged.
Vagabond. (Under Chap. 272, Secs. 53, 68.) That A. B., for three months next before the making of this complaint, was a vagabond, and wandered about from place to place, neglecting all lawful calling and employment, and not having any home or means of support.
Vagrant. (Under Chap. 272, Sec. 66.) That A. B., during the three months next before the making of this complaint, was an idle person who, not having visible means of support, lived without lawful employment (and wandered abroad and visited tippling shops, and lodged in outhouses, and in the open air, and did not give a good account of himself, and wandered abroad and begged, and went about from door to door and placed himself in public places to beg and to receive alms).
The complaint may stop at the word "employment", or such part of the matter in parentheses may be added as the case requires.
Common nuisance. That A. B., during the three months next before the finding of this indictment, at said (Boston), did keep and maintain a certain tenement resorted to by habitual users of narcotic drugs for the purpose of using narcotic drugs.
Unlawful possession. That A. B. did have in his possession unlawfully certain narcotic drugs, to wit, morphine (or cocaine or heroin or the name of the drug as it is commonly known).
Unlawful possession with intent to sell. That A. B. did have in his possession, with intent unlawfully to sell and deliver, a certain narcotic drug (naming the drug.
Conspiracy. That A. B. and C. D. conspired together to engage in unlawful traffic in narcotic drugs.
Sale and delivery. That A. B. did unlawfully sell (or give away or deliver) a narcotic drug, to wit, morphine (or name drug is commonly known by).
Unlawful prescribing and delivery, etc., by physician, etc. That A. B., a physician (or pharmacist or dentist or veterinarian, etc.), did unlawfully prescribe (or sell, give away, furnish or deliver) a certain narcotic drug, to wit, (naming it).
False making of prescription. That A. B. did falsely make (or alter) a prescription for a narcotic drug.
Uttering a false prescription. That A. B. did utter and publish as true a certain false prescription for a narcotic drug, well knowing the same to be falsely made (or altered).
Misrepresentation. That A. B. did falsely represent to C. D. (a physician, or dentist, veterinarian, pharmacist, etc.), for the purpose of obtaining a narcotic drug, that (state the substance of the statements claimed to be representations).
Mass. Gen. Laws ch. 277, § 79