Free Plymouth Registry of Deeds - Massachusetts

DECLARATION OF HOMESTEAD Elderly or Disabled Person
I/WE, _____________________________________________________________
Name(s) of Declarant(s)

owning and occupying as a principal residence the property at
_______________________________________________
(Street Address)

in ______________________
(City/Town)

Plymouth County, Massachusetts, ( ) ( ) being 62 years of age or older; being physically or mentally disabled and because of such disability, not able to engage in substantial gainful employment;

which property was acquired by ( ) inheritance from _________________________________________________ Probate Court # ________________________ deed from ______________________________________________________ dated _______________ and recorded in Plymouth County Registry of Deeds, Book __________ Page __________ Certificate of Title # ________________. LOT(S) ________________on Pan No. ________________ filed with Certificate of Title No.____________ Plymouth County Registry of Deeds, Land Court Division.

( )

( )

hereby declare a homestead in said premises under the provisions of Chapter 188, Section 1A, of the General Laws of Massachusetts. Witness my / our hand and seal this _____ day of _________________, 20_____

Signature ________________________________ Print Name _______________________________ Signature ________________________________ Print Name _______________________________

Return to this address:

Page 1 of 2

Plymouth County Registry of Deeds, 50 Obery St., Plymouth, MA 02360 ­ John R. Buckley, Jr., Register Tel: 508-830-9200 or on the web- regdeeds.plymouth.ma.us

Commonwealth of Massachusetts ss. County of Plymouth

On this the _______ day of _______________, ___________, before me,
Day Month Year

__________________________________, the undersigned Notary Public,
Name of Notary Public

personally appeared _________________________________________________
Name(s) of Signer(s)

proved to me through satisfactory evidence of identity, which was/were __________________________________________________________________
Description of Evidence of Identity

to be the person(s) whose name(s) is/are signed on the preceding or attached document, and acknowledged to me that he/she/they signed it voluntarily for its stated purpose(.) as partner(s) for _________________
Name of Partnership

___________________________, a partnership. as __________________________________ for
Title of Office

___________________________, a corporation.
Name of Corporation

as attorney in fact for _____________________ ___________________________, the principal.
Name of Principal Signer

as______________________, for ___________
Type of Capacity

____________________, a/the _____________.
Name of Person/Entity Type of Entity

_______________________________________
Signature of Notary Public

_______________________________________
Printed Name of Notary Place Notary Seal and/or Any Stamp Above My Commission Expires

_________________

Page 2 of 2
Plymouth County Registry of Deeds, 50 Obery St., Plymouth, MA 02360 ­ John R. Buckley, Jr., Register Tel: 508-830-9200 or on the web- regdeeds.plymouth.ma.us