Declaration Of Homestead Form

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COMMONWEALTH OF MASSACHUSETTS
SUFFOLK COUNTY REGISTRY OF DEEDS
FRANCIS “MICKEY” ROACHE, REGISTER
A Division of the Secretary of the Commonwealth
William Francis Galvin, Secretary
BOSTON
CHELSEA
WINTHROP
REVERE
DECLARATION OF HOMESTEAD
KNOW ALL MEN BY THESE PRESENTS THAT:
I, ___________________________________ of ___________________________________________
(PRINT NAME OF INDIVIDUAL HOMEOWNER)
(PRINT CITY OR TOWN OF WHERE PROPERTY IS LOCATED)
County of Suffolk and Commonwealth of Massachusetts, as a Householder and being entitled to an
estate of Homestead in the land and building thereon hereinafter described, do declare that I own
and am possessed and occupy, or intend to occupy and possess, said premises as my principal
residence and homestead under Massachusetts General Laws, Chapter 188, §1 as amended to wit:
(DESCRIPTION OF PROPERTY)
Book Number: ____________
Number/Street: _________________________________________
Page Number: _____________
City or Town, State, Zip:
_______________________________
Registered Land
Certificate of Title Number: _______________
WITNESS my hand and seal this ____________ day of ________________________, ___________.
X__________________________________
(Signature of Individual Homeowner)
COMMONWEALTH OF MASSACHUSETTS
, ss.
On this ____ day of ________________, 20___, before me, the undersigned notary public, personally
appeared __________________________________(name of document signer), proved to me through
satisfactory evidence of identification, which were ______________________, to be the person whose
name is signed on the preceding or attached document, and acknowledged to me that he/she signed
it voluntarily for its stated purpose.
X _____________________________
(Notary Public)
(Print Name)
My Commission Expires: ________
After recording please return to:
Name: _____________________________________
TO RECORD BY MAIL SEND COMPLETED
FORM, SASE, AND FILING FEE TO:
Address: ___________________________________
SUFFOLK COUNTY REGISTRY OF DEEDS
EDWARD W. BROOKE COURTHOUSE
City/State: ___________________ Zip___________
24 NEW CHARDON STREET, P.O. BOX 9660
BOSTON, MA 02114-9660

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