DECLARATION OF HOMESTEAD ELDERLY OR DISABLED PERSON
_____________________________________________________________________________ (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 an elderly or disabled person's homestead in said premises under the provisions of Chapter 188, Section 1A, of the General Laws of Massachusetts. Executed as sealed instrument this ______________day of________________, ________ _____________________________________ ___________________________________ Signature(s) =================================================================== 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 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