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    Statement of Information: Confidential Information For Your Protection

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    api-25884946
    This document collects confidential personal information from parties involved in a property transaction, including their full names, dates of birth, social security numbers, driver's license numbers, residences and occupations for the past 10 years, and marital history. It asks whether there are any liens, defects or other issues affecting the property, who is entitled to possession, and whether any construction has been done. Both parties must sign for title insurance to be written.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Statement of Information: Confidential Information For Your Protection

    Uploaded by

    api-25884946
    100 views1 page
    This document collects confidential personal information from parties involved in a property transaction, including their full names, dates of birth, social security numbers, driver's license numbers, residences and occupations for the past 10 years, and marital history. It asks whether there are any liens, defects or other issues affecting the property, who is entitled to possession, and whether any construction has been done. Both parties must sign for title insurance to be written.

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    This document collects confidential personal information from parties involved in a property transaction, including their full names, dates of birth, social security numbers, driver's license numbers, residences and occupations for the past 10 years, and marital history. It asks whether there are any liens, defects or other issues affecting the property, who is entitled to possession, and whether any construction has been done. Both parties must sign for title insurance to be written.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    100 views1 page

    Statement of Information: Confidential Information For Your Protection

    Uploaded by

    api-25884946
    This document collects confidential personal information from parties involved in a property transaction, including their full names, dates of birth, social security numbers, driver's license numbers, residences and occupations for the past 10 years, and marital history. It asks whether there are any liens, defects or other issues affecting the property, who is entitled to possession, and whether any construction has been done. Both parties must sign for title insurance to be written.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    STATEMENT OF INFORMATION

    CONFIDENTIAL INFORMATION FOR YOUR PROTECTION


    This statement is to be signed personally by each party to the transaction and by both husband, wife or domestic partner before title
    insurance can be written. When filled in completely it will serve to establish identity, eliminate matters affecting persons of similar
    name, protect you against forgeries, and speed the completion of your transaction.

    MY FULL NAME (First, Middle, Last): ______________________________________________ Date of Birth: ________________


    Business Ph: _______________________ Home Ph: _______________________ Birthplace: _______________________________
    SS#: ______________________ Driver’s License No.: ______________________ Expiration Date: ___________ State Issued: ____
    I have lived continuously in the USA since:_________________________________________________________________________
    Spouse/Domestic Partner’s Birthplace: _____________________________________________ Date of Birth: __________________
    Spouse/Domestic Partner’s SS#: ______________________ I have lived continuously in the USA since: _______________________
    We were legally married/legally joined on: _________________________ at _____________________________________________
    Spouse/Domestic Partner’s Maiden Name: _________________________________________________________________________

    RESIDENCES & OCCUPATIONS DURING THE PAST 10 YEARS

    Street ______________________________________ City _____________________________ From ___________ to ___________


    Street ______________________________________ City _____________________________ From ___________ to ___________
    Street ______________________________________ City _____________________________ From ___________ to ___________

    OCCUPATIONS
    Husband/Domestic Partner Firm Name: __________________________________ Location: _____________________________
    Firm Name: __________________________________ Location: _____________________________
    Firm Name: __________________________________ Location: _____________________________

    Wife/Domestic Partner Firm Name: __________________________________ Location: _____________________________


    Firm Name: __________________________________ Location: _____________________________
    Firm Name: __________________________________ Location: _____________________________

    If no former marriage/union, write “none”. Otherwise, complete the following:


    Former Marriages Name of former husband/domestic partner: _______________________________________________________
    Check one item/fill Deceased Divorced Interlocutory Final When: ___________ Where: _____________________
    in date and place Name of former wife/domestic partner: __________________________________________________________
    Deceased Divorced Interlocutory Final When: ___________ Where: _____________________

    There are no leases, defects, encumbrances, adverse claims, or other matters affecting said property other than as shown on the
    Preliminary Report prepared by:__________________________________________________________________________________
    Bearing the above referenced order number dated: ___________________________________________________________________
    There is no one in possession or entitled to possession of said property other than the Vestee shown in said Preliminary report
    except: ______________________________________________________________________________________________________
    There is no work of improvement in progress and no such work has been completed within one year of this date:
    (Circle One) YES NO

    The street address of the property in this transaction is: _______________________________________________________________


    Single Family Residence Multiple Residence Commercial Vacant Land
    Occupied by: Owner Lessee Tenants
    Is any portion of new loan funds to be used for construction? (Circle One) YES NO

    Date: __________________________ __________________________________________________


    (Signature)

    __________________________________________________
    (Signature)

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