DECLARATION OF HOMESTEAD
KNOW ALL MEN BY THESE PRESENTS THAT I, _____________________________________ (Name)
of _______________________________________________ COUNTY OF WORCESTER AND
(City or Town) COMMONWEALTH OF MASSACHUSETTS as Householder, and having a family or sole owner and being entitled to an Estate of Homestead in the land and buildings hereinafter described, do hereby declare that I own, possess and occupy said premises as a residence and homestead under Massachusetts General Laws, Chapter 188, as amended to wit: Property Location: __________________________________________________________ (Street address, City and Zip Code) Deed Reference: Book __________ Page __________
Witness my hand and seal this ___________________ day of __________________, 20_____ _________________________________________
COMMONWEALTH OF MASSACHUSETTS Worcester, SS. Date ____________________
On this day before me, the undersigned notary public, personally appeared _________________ ________________________, proved to me through satisfactory evidence of identification, which were ___________________________, to be the person whose name is signed on the above document, and acknowledged to me that he/she signed it voluntarily for its stated purpose. ________________________________________ Notary Public My Commission Expires: