RECORDING REQUESTED BY

AND WHEN RECORDED MAIL TO

HOMESTEAD DECLARATION

I, _______________________________________________, hereby certify and declare:

(a) I hereby claim as a declared homestead the premises described as follows:

(b) I am the declared homestead owner of the above-declared homestead.

(c) I own the following interest in the above-declared homestead: ___________________________________.

(d) The above-declared homestead is _________________ (my principal dwelling or the principal dwelling of my spouse), and ________________________________ is currently residing in that declared homestead.

(e) My further act of causing this declaration to be recorded shall constitute a representation that ___________________________ reside(s) in the above-declared homestead on the date this declaration is recorded.

(f) The facts stated in this Declaration are true as of my personal knowledge.

Dated: _________________

________________________________________

CERTIFICATE OF ACKNOWLEDGEMENT OF NOTARY PUBLIC

STATE OF CALIFORNIA, )

COUNTY OF _________________)

On ________________________ before me, ________________________________, (here insert name and title of the officer), personally appeared ____________________________________, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Signature ____________________________________________ (Seal)