Declaration Of Homestead Form

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DECLARATION OF HOMESTEAD
Assessor Parcel Number: _____________________________________________
OR
Assessor’s Manufactured Home ID Number: ____________________________
Recording Requested by and Mail to:
Name: _____________________________________________________________
Address: ___________________________________________________________
City/State/Zip: ______________________________________________________
Check One:
 Married (filing jointly)
 Married (filing individually)
 Head of Family
 Widowed
 Single Person
 Multiple Single Persons
 By Wife (filing for joint benefit of both)
 By Husband (filing for joint benefit of both)
 Other (describe): ____________________________________________________________________________________
Check One:
 Regular Home Dwelling/Manufactured Home
 Condominium Unit
Other
Name on Title of Property
___________________________________________________________________________________________________
do individually or severally certify and declare as follows:
___________________________________________________________________________________________________
is/are now residing on the land, premises (or manufactured home) located in the city/town of __________________________,
County of ______________________, State of Nevada, and more particularly described as follows:
(set forth legal description and commonly known street address OR manufactured home description)
I/We claim the land and premises hereinabove described, together with the dwelling house thereon, and its appurtenances, or
the described manufactured home as a Homestead.
In Witness, Whereof, I/we have hereunto set my hand/our hands this _____day of ______________________, 20_____.
_______________________________________________
____________________________________________
Signature
Signature
______________________________________________
____________________________________________
Print or type name here
Print or type name here
STATE OF NEVADA, COUNTY OF _____________________
Notary Seal
This instrument was acknowledged before me on ____________
(date)
by _________________________________________________
Person(s) appearing before notary
by _________________________________________________
Person(s) appearing before notary
____________________________________________________
Signature of notarial officer
CONSULT AN ATTORNEY IF YOU DOUBT THIS FORM’S
FITNESS FOR YOUR PURPOSE.
NOTE: Leave space within 1-inch margin blank on all sides.
Oct. 2009
Form 654

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