Fillable Printable Declaration of Homestead for Homes Owned by Natural Persons - The Commonwealth of Massachusetts

Declaration of Homestead for Homes Owned by Natural Persons - The Commonwealth of Massachusetts

The Commonwealth of Massachusetts

William Francis Galvin, Secretary of the Commonwealth

Declaration of Homestead for Homes Owned

by Natural Persons (General Laws Chapter 188)

In situations where the home is owned by multiple owners, each owner may

be best served to complete a separate declaration of homestead.

1. I, _______________________________________________________________,

(insert name of owner)

We, ______________________________________________________________,

(insert name of owners)

_________________________________________________________________ ,

hereby declare homestead pursuant to M.G.L. c.188 and state that I/we own the home

described below and occupy or intend to occupy the home as my/our principal residence.

Owner Information

2. Check all that apply:

I/we, _____________________________________________________________________ am elderly (62 years of age or older).

(insert name (s))

I/we, _________________________________________________________________________________________________

(insert name (s))

am/are disabled (have a physical or mental impairment that meets the disability requirements for Supplemental Security Income

under 42 U.S.C. 1382c(a)(3)(A) and 42 U.S.C. 1382c(a)(3)(C). One of the following must be attached: 1) an original or certied

copy of a disability award letter issued to the person by the United States Social Security Administration, or 2) a letter signed by a

physician registered with the board of registration in medicine certifying that each person meets the disability requirements stated

in 42 U.S.C. 1382c(a)(3)(A) and 42 U.S.C. 1382c(a)(3)(C).

I am married to _________________________________________________________________________________________ ,

who is not a co-owner of the home but who occupies or intends to occupy the home as his/her principal residence.

I/we, _________________________________________________________________________________________________

(insert name (s))

am/are servicemember(s) who may be subject to protection under the servicemember(s) Civil Relief Act, 50 U.S.C. 553, should I/we

be called to active duty.

Home Information

3. Address: ______________________________________________________________________________________ , Massachusetts.

(street number and name, city/town)

4. Select ONE of the following:

Deed is recorded in __________________________________ Registry of Deeds in ______________ and _______________

(district/county) (book) (page)

Certicate of Title _________________ registered in the Land Registration Oce ______________ and _______________

(number) (book) (page)

Inheritance from _________________________________________________________________________ , Docket number

(name of previous owner)

_______________________________________________ in ________________________________________________.

(number) (county)

For manufactured homes, license number __________________________________________________________________ .

(number)

Filing Fee $35

(over)

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5. I/we, whose names are signed on this document, acknowledge that I/we sign it voluntarily for its stated purpose.

To be signed by Applicant(s) in front of Notary Public.

Signed under pains and penalties of perjury this

_______________________________________________day of _____________________________________________ , 20 ______.

____________________________________________________________________________________________________

For Use by Notary Public Only:

COMMONWEALTH OF MASSACHUSETTS

_______________________________________________, ss.

________________________________________, 20 ______ , before me, the undersigned notary public, personally appeared

____________________________________________________________________________________________________ ,

(name(s) of the document signer(s))

proved to me through satisfactory evidence of identication, which were ___________________________________________ ,

(drivers license, passport, etc.)

to be the person(s) who signed the preceding or attached document in my presence, and who swore or armed to me that the contents of

the document are truthful and accurate to the best of (his) (her) (their) knowledge and belief.

Notary Public: ____________________________________________________________________________________________

My commission expires: _____________________________________________________________________________________

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