Loan Star Title Information Form Property Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Seller Name * First Name Last Name Home Phone (###) ### #### Work Phone (###) ### #### Cell Phone (###) ### #### Email * Forwarding Address After Closing Address 1 Address 2 City State/Province Zip/Postal Code Country Will You be attending the Closing? * Yes No Do you currently occupy the property? * Yes No If No, when did you vacate? Do you have an existing survey? Yes No SELLER #1 * Date of Birth MM DD YYYY * Social Security Number * Are you a U.S. Citizen? Yes No If no, do you have a Permanent Resident Card? Yes No SELLER #2 Date of Birth MM DD YYYY Social Security Number Are you a U.S. Citizen? Yes No If no, do you have a Permanent Resident Card? Yes No Seller Marital Status * IF MARRIED Are the spouse's names shown above as "Seller"? Yes No Spouse's full Legal Name Did spouse ever reside at the property address? Yes No IF SINGLE Single When acquired property and remained single Married when acquired property If Married when aquired property, specify that the marriage ended in divorce/death on or about MM DD YYYY filed in Fill out the following section only if you have Existing Loan(s) on the property so that we may order the Loan Payoff. This section should only be completed if you have a lien on the property. (1) Mortgage Company Phone Number (###) ### #### Loan Number Address (2) Mortgage Company Phone Number (###) ### #### Loan Number Address (3) Mortgage Company Phone Number (###) ### #### Loan Number Address Seller 1 * I authorize Loan Star Title Company to order and receive a payoff statement First Name Last Name Seller 2 I authorize Loan Star Title Company to order and receive a payoff statement First Name Last Name Thank you for your submission!
