In order to secure the benefit of the exemptions of real estate under §§ 34-4 and 34-4.1, the householder, by a writing signed by him and duly admitted to record, to be recorded as deeds are recorded, in the county or city wherein such real estate or any part thereof is located or, if such property is located outside of the Commonwealth, in the county or city in the Commonwealth where the householder resides, shall declare his intention to claim such benefit and select and set apart the real estate to be held by the householder as exempt, and describe the same with reasonable certainty, affixing to the description his cash valuation of the estate so selected and set apart. However, if such real estate is claimed exempt in a case filed under Title 11 of the United States Code, the official Schedule of Property Claimed as Exempt filed in the United States Bankruptcy Court claiming such exemptions shall be sufficient to set apart such property as exempt. Equitable as well as legal estates may be so selected and set apart. The following form, or one which is substantially similar, shall be used and shall be sufficient for the writing required by this section: HOMESTEAD DEED FOR REAL PROPERTY Name of Householder __________________ Name of title holder of record (if different) __________________ Is the householder a disabled veteran entitled to claim the additional exemption under § 34-4.1? ________________ Address of Householder __________________ Name(s) and age(s) of dependent(s) __________________ County/city/state in which real property claimed as exempt is located __________________ __________________ Description of property claimed as exempt __________________ __________________ Value of property described above __________________ Number of homestead deeds that have been filed by the Householder __________________ Exemption amount previously claimed on prior homestead deeds __________________ List the jurisdictions where previous homestead deeds were filed __________________ __________________ (Signature of Householder) __________________ [ACKNOWLEDGMENT] Such writing or deed shall not be required to secure any exemption under this Code except those exemptions created by §§ 34-4 and 34-4.1.