Free Hampden Registry of Deeds - Massachusetts

DECLARATION OF HOMESTEAD HAMPDEN COUNTY REGISTRY OF DEEDS

DONALD E ASHE, Register
I/We __________________________________________________________________________________________________ (applicants must be OVER 62 years of age or disabled) I _____________________________________________________________________________________________________ (one name only if UNDER 62 years of age) Owning and residing at ___________________________________________________________________________________ (street address) in ________________________________________________________________________, Hampden County, Massachusetts, (City) Acquired via: Inheritance from ___________________________________________ (Previous owner) Deed from ________________________________________________ (Previous owner) Probate No.____________________________

Dated ________________________________

And recorded in the Registry of Deeds Book ___________________________________ Page __________________________ Or as Certificate of Title # ________________________________________________ (if recorded in the Land Court Dept.) Hereby declare that I/We hold said real estate as a homestead under the provisions of Chapter 188, sections 1 or 1A of the General Laws of Massachusetts and expressly reserving the right to myself (and my spouse) or to the survivor of us, or our legal representatives, to revoke and rescind this Homestead as to ourselves and to the rights of our minor, unmarried children. The remainder of this form shall be completed in the presence of a Notary Public. Witness my/our hand(s) and seal(s) this __________________ day of _________________________________, 20__________ Signature(s): __________________________________________________________________________________________

___________________________________________________________________________________________

COMMONWEALTH OF MASSACHUSETTS

_________________________________________, ss.,

On this ___________ day of ___________________ 20______, before me, the undersigned notary public, personally appeared

______________________________________________________________________________________________________ The above-named, Proved to me through satisfactory evidence of identification, which was/were, _______________________________________ ____________________________________To be the person(s) whose name(s) is/are signed on this document in my presence, and acknowledged the foregoing to be his/her/their free act and deed before me. ____________________________________________________ , Notary Public My commission expires: _______________________________