DECLARATION OF HOMESTEAD FOR
DISABLED PERSONS KNOW ALL MEN BY THESE PRESENTS THAT I/We, _________________________________________ ________________________________of ____________________________COUNTY OF WORCESTER AND COMMONWEALTH OF MASSACHUSETTS as a homeowner and being entitled to an Estate of Homestead in the land and buildings hereinafter described, am filing for protection as a disabled person, I do hereby declare that I utilize said premises as my principal residence under Massachusetts General Laws, Chapter 188, as amended to wit: Property Location: __________________________________________________________ Deed Reference: Book ________ Page ________ Attach Physician's letter here
OR
Original or certified copy of SS disability award letter
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: