Declaration by wife.
I, _________, certify and declare as follows, namely:
1. That I am a married woman and my husband has not made any declaration of homestead, and I make this declaration for our joint benefit.
2. That we purchased the described property for a homestead and intend to reside there and are now actually residing there.
3. That I claim the premises described as a homestead.
4. That I estimate the actual cash value of the premises described to be approximately $_____. That the same is subject to a real estate mortgage held by the _________ bank, in the amount of approximately $_____ and that the value of our equity is approximately $_____.
5. That the premises referred to and which is claimed as a homestead is situated in _________ County, State of _________, and is legally described as follows, namely: _________.
In witness, I have set my hand below this _________, 19__.
This is to certify that on this _________, 19__, before me, the undersigned, a notary public in and for the state of _________, duly commissioned, sworn and qualified, personally appeared _________, known to me to be the individual described in and who executed the above instrument, and acknowledged to me that she signed and sealed the same as her free and voluntary act and deed for the uses and purposes mentioned in it.
Witness my hand and official seal the date in this certificate first written above.
_________, Notary Public in and for the state
of _________, residing at _________.
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