Free Essex North Registry of Deeds - Massachusetts

Filing Fee: $35

The Commonwealth of Massachusetts
William Francis Galvin, Secretary of the Commonwealth Robert F. Kelley, Northern Essex District Register of Deeds

Declaration of Homestead

(General Laws Chapter 188, Sections 1 and 1A)
1. Name: ___________________________________________________________ , and _____________________________________________________________________ (add a second name only if EldErly (over 62 years of age) or disablEd 2. Property Address: ______________________________________________________ (street number and street name) ________________________________________________________ , Massachusetts. (city or town) 3. Select ONE of the following: For Recorded Land (Deed/Inheritance): The deed being recorded in _______________________ ______________________ (book) (page) or _______________________ from _______________________ Probate Court. (docket number) (county) OR For Registered Land (Certificate of Title): As Certificate of Title ________________________________ registered in the Land (number) Registration Office in ________________________ (book) 4. Check if ELDERLY (over 62 years of age) or DiSAbLED: I (We), being 62 years of age or older or being physically or mentally disabled and because of such disability, am (are) not able to engage in substantial, gainful employment, which disability is evidenced by the attached award letter from the Social Security Administration or certification by a physician licensed by the Commonwealth of Massachusetts. I (We) hereby declare that I (we) am (are) possessed of, and occupy said premises as a residence and Homestead as provided in Chapter 188, Section 1 or 1A, of the Massachusetts General Laws, as amended. I (We) expressly reserve the right to myself and my spouse, or to the survivor of us, our legal representatives, to revoke and rescind this Homestead as to ourselves and the rights of our minor, unmarried children. To be Signed by Applicants in Front of Notary Public: Witness my (our) hand(s) and seal this _______________________________ day of ________________________ , 20 _____. Signature(s): __________________________________________________________________________________________ For Use by Notary Public Only: COMMONWEALTH OF MASSACHUSETTS ________________________________________ , ss. ________________________________________, 20 ______ , before me, the undersigned notary public, personally appeared ____________________________________________________________________________________________________ , (name(s) of the document signer(s)) proved to me through satisfactory evidence of identification, which were ___________________________________________ , (drivers license, passport, etc.) to be the person(s) whose name is (are) signed on the preceding or attached document in my presence. Notary Public: ________________________________________________ My commission expires: ___________________________ _________________________ . (page)