Free Elderly Homestead.PDF - Massachusetts

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
(SPECIAL HOMESTEAD PROTECTION FOR ELDERLY OR DISABLED PERSONS)

KNOW ALL MEN BY THESE PRESENTS THAT:
(PRINT NAME OF INDIVIDUAL HOMEOWNER)

I, ___________________________________ of ___________________________________________
(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, am filing for homestead protection as an elderly (age 62 or older) or permanently disabled person. I 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, § 1A as amended to wit:
(DESCRIPTION OF PROPERTY)

Book Number: ____________ Page Number: _____________

Number/Street: _________________________________________ 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: _____________________________________ Address: ___________________________________ City/State: ___________________ Zip___________ TO RECORD BY MAIL SEND COMPLETED FORM, SASE, AND FILING FEE TO: SUFFOLK COUNTY REGISTRY OF DEEDS EDWARD W. BROOKE COURTHOUSE 24 NEW CHARDON STREET, P.O. BOX 9660 BOSTON, MA 02114-9660