Declaration Of Homestead

1. I/We _______________________________________________________________, Do Hereby Declare:

2. That My/Our Mailing Address For My/Our Homestead is:

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________________________________________________
________________________________________________
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3. I/We Am/Are Now Residing On The Land And Premises Located In The City of ________________________,
County of _______________________, State of _______________________________ Known And Legally
Described As Follows:

4. I/We Hereby Declare And Claim Said Premises As A Homestead.

5. No Further Declaration Of Homestead Has Been Made By Me/Us Except As Has Be Abandoned.

Date: __________________________________________

State of ___________________________) ) ss.

County of _________________________)

I/We, __________________________________, Being Duly Sworn On Oath, Deposes And Says: That As Signer
To This Declaration Of Homestead, All Statements Made Herein Are True And Correct, To The Best Of My/Our
Knowledge And Belief. Subscribed And Sworn To Before Me, This __________ Day Of ___________________
20_________

_______________________
Notary Public

My Commission Expires _______________________