Palmer Abstract Co., Inc. - Online Order Form 503 N. Van Buren St., Marion, IL 62959 Phone: 618 993-3866 Fax: 618 997-0468 NOTE: Items marked with a (*) must be completed for a buy/sell transaction in order for your documents to be recorded in a timely manner. Date (*): From (*): Email (*): Phone Number (*): ------------------------------------------------ SELLER ------------------------------------------------ Name (*): MarriedH & WSingleDivorcedWidow(er)Deceased Current Mailing Address: Mailing Address After Sale (*): Reporting Social Security Number (*): Daytime Phone # (*): If any of the present title holders are deceased, please disclose name, date, and where they passed away. Seller's Agent: ------------------------------------------------ BUYER ------------------------------------------------ Name (*): As to appear on deed (*): MarriedH & WSingleDivorcedWidow(er)Deceased Manner title to be held: Joint TenantsTenants in CommonTrustTenants by the EntiretySole Owner Current Mailing Address: Mailing Address After Sale: Address for Tax Bill (*): Buyer's Agent: ------------------------------------------------ TRANSACTION ------------------------------------------------ Address being sold: (*) Sale Price $ (*) Owner's Policy Amt $ Backup Policy # Tax ID # Deed PrepYesNo Lot size/Number of Acres Lender FinancingYesNo Cash Transaction/No Financing YesNo Bank/Lender Bank Address Loan Officer Lender's Phone Lender's email Mortgage Policy Amt $ (*) Delivery methodEmailPickupMailFax Title Report OnlyYesNo DispositionSecondary Market with EndorsementsIn House ------------------------------------------------ PROPERTY'S USE ------------------------------------------------ Vacant Land/LotCurrentIntended ResidenceCurrentIntended Mobile Home ResidenceCurrentIntended Office CurrentIntended Retail Establishment Current Intended Commercial building CurrentIntended Industrial Building CurrentIntended Farm CurrentIntended Apartment Building CurrentIntended # Units if applicable: Other Current Intended If "other" please describe here ------------------------------------------------ HISTORY ------------------------------------------------ Was the property the seller's primary residence? YesNo Was the property advertised for sale? YesNo Fulfillment of Contract for Deed? YesNo If contract for deed, what year will fulfillment occur? Will Palmer Abstract Company close? YesNo Date Requested Comments
