DECLARATION OF HOMESTEAD
_____________________________________________________________________________ (name) owning and occupying as my principal residence the real estate at _____________________________________________________________________________ (street address) in ______________________________, Norfolk County, Massachusetts, owned by me by (community) Deed Recorded in BOOK___________PAGE________of the NORFOLK REGISTRY OF DEEDS Certificate of Title #_______________in NORFOLK REGISTRY DISTRICT OF THE LAND COURT Inheritance from__________________________________________ _______________________Probate Court #___________________ hereby declare a homestead in said premises under the provisions of Chapter 188, Section 1, of the General Laws of Massachusetts. Executed as sealed instrument this ______________day of________________, ________ ________________________________________ Signature =================================================================== Commonwealth of Massachusetts ________________________ss On this ____ day of ___________, 20___, before me, the undersigned notary public, personally appeared _____________________________ (name of document signer), proved
_____________________, to be the person whose name is signed to the foregoing, and acknowledged to me that he or she signed it voluntarily for its stated purpose.
______________________________________ Notary Public My Commission Expires: ===================================================================
Norfolk County Registry of Deeds, 649 High St., Dedham, MA 02026-1831 ~ William P. O'Donnell, Register