I, ______________________________________ of _____________________________
Massachusetts hereby states and declares as follows:
1) That I am the Trustee of the ___________________ Trust Declaration of which is dated ____________ and recorded with the __________County Registry of Deeds in Book _____ Page________ or the ___________County Registry District of the Land Court as Document __________ and noted on Certificate of Title_______________ or established pursuant to ____________County Probate case # ________________
2) That home and property known as ___________________,________________, Massachusetts was vested in the ________________ Trust by a deed recorded with the __________County Registry of Deeds in Book _____ Page________ or the ___________County Registry District of the Land Court as Document __________ and noted on Certificate of Title_______________ or vested in ___________________Trust pursuant to ____________County Probate case # ________________
3) That pursuant to the terms of said Trust and by permission of the Trustee ________________ Beneficiaries of said trust occupy or intend to occupy the said home and property as their principal residence.
4) That I hereby declare a homestead in said home and property under the provisions of MGL Chapter 188, § 3.
Signed under the penalties of perjury this day of__________, 20__________
_______________________________________
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 whose name is signed on the preceding or attached document, and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of his/her knowledge and belief.
____________________________
Notary Public
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