Seller 1

Name

First

Middle

Last

Seller 2

Name

First

Middle

Last

Property Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Marital Status

Single
Married
Divorced
Widow/Widower

Spouse's Name

Is the forwarding address known/available?

Yes
No

Forwarding Address

Address Line 1

Address Line 2

City

State

Zip Code

Homeowner’s Association/Townhome Association

Yes
No

Homeowner’s Association/Townhome Association

Association Name

Contact Name

Phone Number

Email

Payment Amount

Frequency

Number Association assessments

Are you aware of any wells, including sealed/capped wells, on the property?

Yes
No

Have you been notified by the city, county, or homeowner’s association of any pending assessments on the property?

Yes
No

Have there been any deaths of owners of the property?

Yes
No

Have any owners filed for bankruptcy?

Yes
No

Date

Have there been any Divorce or Dissolution Proceedings?

Yes
No

Date

Seller Information

Seller 1

Seller 2

Homeowner’s Association/Townhome Association

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