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Certificate of
Participation

DECLARATION OF HOMESTEAD

KNOW ALL MEN BY THESE PRESENTS that I _____________________________________ of

____________________________________________ County of

___________________________________________ and Commonwealth of Massachusetts as a 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 and am possessed and occupy said premises as a residence and homestead under Massachusetts General Laws, Chapter 188 as amended, to wit:

Property Location: ___________________________________________

Deed Refference: Book ________

Page _______

WITNESS my hand and seal this ______________day of ______________19____

__________________________________________

COMMONWEALTH OF MASSACHUSETTS

___________________________.ss ________________________, 19_________

Then personally appeared the above-named ______________________________________ and acknowledged the foregoing Instrument to be his free act and deed, before me,

______________________________________________
Notary Public-Justice of the Peace

My Commission Expires _________________________, 19____________