TRI COUNTY TITLE AGENCY

Listing Questionnaire

In order to provide the best possible service and to ensure there are no delays in the closing process we ask that
you complete the following form and PROVIDE A COPY OF THE PREVIOUS TITLE POLICY FROM THE
PURCHASE OF YOUR HOME.

Please provide the following Information:

What date did you obtain property? Date: ________________________________________

Has there been a recent death of a titleholder? No Yes Name _____________________________

Has there been a recent marriage of a titleholder? No Yes
Is title held in a business? No Yes Copies of Paperwork will be required
Has there been a divorce since obtaining property? No Yes Executed Copy of Divorce Decree is needed
Is title held in a trust? No Yes Copy of Trust or certificate is needed
Does anyone else have an interest in title? No Yes Name(s) ___________________________
Are you using a power of attorney? No Yes Please provide a copy (original will be needed)
Any 2nd mortgages or equity loans on the property? No Yes Please fill out a payoff authorization
Is property a mobile home (does it have a title?) No Yes Please provide title
Is property in foreclosure or are you behind on payments? No Yes Details: _____________________________
Have there been any title or boundary disputes? No Yes
Have you had a bankruptcy since purchasing property? No Yes Date: ______________________________
Are there any liens about to be filed? No Yes
Do you have knowledge of any special assessments? No Yes Type of assessment(s)______________________
Do you have knowledge of delinquent taxes? No Yes
Is home newly built? No Yes Date house completed: ____________________
Is property a rental or income? No Yes Copies of Lease(s) will be needed
Is your mortgage an adjustable rate? No Yes When does rate change? ___________________
Is there a homeowners association? No Yes Contact Name & Phone:____________________
Have you provided a copy of previous title policy? No Yes

PLEASE COMPLETE THE FOLLOWING PAGE REGARDING PAYOFF INFORMATION