Fillable Commonwealth of Massachusetts Transfer of Ownership Notification

Fill Online, Printable, Fillable, Blank Commonwealth of Massachusetts Transfer of Ownership Notification Form

Use Fill to complete blank online COMMONWEALTH OF MASSACHUSETTS (MA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Commonwealth of Massachusetts Transfer of Ownership Notification

On average this form takes 4 minutes to complete

The Commonwealth of Massachusetts Transfer of Ownership Notification form is 2 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 16 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
The Commonwealth of Massachusetts
Executive Office of Elder Affairs
One Ashburton Place, 5th Floor
Boston, Massachusetts 02108
Transfer of Ownership Notification
In accordance with the Massachusetts Assisted Living Regulations 651 CMR 12.03(8), the
application for a Change of Ownership must include a statement signed and notorized by the
parties, regarding the anticipated transfer of Ownership of the Residence.
Assisted Living Residence (ALR) to be transferred:
_____________________________________________________________________
ALR Name
_____________________________________________________________________
Address
_____________________________________________________________________
City/ Town Zip code
The undersigned representative of the above named ALR confirms the intent to sell the
ownership entity to:
_________________________________________________________________________
The anticipated date of the transfer is: _________________________________
SELLER:
____________________________________________________________
Name of current ownership entity
____________________________________________________________
Signature of Person Authorized to sign for the current owner (Officer, Trustee or Individual)
____________________________________________________________________
Print Name & Title of Person Authorized
Change of Ownership - Seller
Page 2 of 2
Notary Signature and Seal:
On this ______day of ___________________________, 20______, the above named individual
proved to me through satisfactory evidence of identification and authorization regarding the
anticipated transfer of Ownership of the Assisted Living Residence identified above.
Subscribed and sworn to before me on this _________day of ____________ 20_________.
My Commission expires: _______________________________________ 20_________.
________________________________ (Seal)
Notary Public
Page 2 of 2
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Commonwealth of Massachusetts Transfer of Ownership Notification

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 10 May 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document