Declaration Of Homestead For Disabled Persons - Commonwealth Of Massachusetts

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DECLARATION OF HOMESTEAD
FOR
DISABLED PERSONS
KNOW ALL MEN BY THESE PRESENTS THAT I/We, _________________________________________
________________________________of ____________________________COUNTY OF WORCESTER AND
COMMONWEALTH OF MASSACHUSETTS as a homeowner and being entitled to an Estate of Homestead in
the land and buildings hereinafter described, am filing for protection as a disabled person, I do hereby declare that
I utilize said premises as my principal residence under Massachusetts General Laws, Chapter 188, as amended to
wit:
Property Location: __________________________________________________________
Deed Reference: Book ________
Page ________
Attach Physician’s letter here
OR
Original or certified copy of SS disability award letter
Witness my hand and seal this ___________________ day of _______________, 20___
_______________________________________
_____________________________________
COMMONWEALTH OF MASSACHUSETTS
Worcester, SS.
Date ____________________
On this day before me, the undersigned notary public, personally appeared _________________
_____________________, proved to me through satisfactory evidence of identification, which were
_____________________, to be the person whose name is signed on the above document, and
acknowledged to me that he/she signed it voluntarily for its stated purpose.
________________________________________
Notary Public
My Commission Expires:

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