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Statement of Information

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Used in accordance with certain loans or property transactions to give necessary information to title companies or escrow.

Statement of Information

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Sample Text: (Formatting does not match the actually Forms)

Please use the (Sample: Static PDF) for the Free Version

1
STATEMENT OF INFORMATION
(For confidential use by the Title Company in searching the records in connection with the fie number shown below.)
Property Address: ________________________________________________ File No.: ____________________
________________________________________________ Ref No.: ____________________
In order to expedite the completion of your transaction we are requesting that you complete the following “statement of
Information” form. We are not unnecessarily interested in your personal affairs, however, we have been asked to insure
the title to real property in which you are interested and that requires a title search.
In searching your title we may encounter judgments, bankruptcies, divorces and/or income tax liens against persons with
the same or similar names to yours. Such matters cloud the title to your property unless eliminated. The information you
provide, and your spouse if you are married, can promptly eliminate all matters not directly affecting you or the property
being searched, avoid any delay in your transaction and provide you with the most efficient service possible.
Thank you for your cooperation in furnishing us with the necessary information and please be assured that your
information is confidential and used only for the purpose which we have stated.
Name: _______________________
First
___________________
Middle – if none, indicate
_______________________
Last US Residence since: __________
Year
Have you ever been known by any other name: No Yes If yes, indicate name: _____________________________________
Social Security Number: _______________________________ Driver License Number: ___________________________________
Date of Birth: _______________________________________ Location of Birth: ________________________________________
Spouse’s Name: _______________
First
___________________
Middle – if none, indicate
_______________________
Last US Residence since: __________
Year
Have you ever been known by any other name: No Yes If yes, indicate name: _____________________________________
Social Security Number: _______________________________ Driver License Number: ___________________________________
Date of Birth: _______________________________________ Location of Birth: ________________________________________
RESIDENCES LAST 10 YEARS (list most recent first)
________________________________
Number and Street
____________________________________________________
City, State, Zip Code
___________________
From/To (Date)
________________________________
Number and Street
____________________________________________________
City, State, Zip Code
___________________
From/To (Date)
________________________________
Number and Street
____________________________________________________
City, State, Zip Code
___________________
From/To (Date)
(attach additional page, if necessary)
OCCUPATIONS
__________________
Occupation
__________________________
Company Name
_____________________________________
Address, City, State, Zip Code
__________________
No. Yrs/Mos
__________________
Spouse’s Occupation
__________________________
Company Name
_____________________________________
Address, City, State, Zip Code
__________________
No. Yrs/Mos
BUSINESS OWNED OR PARTNERSHIP AFFILIATIONS
__________________
Tax ID Number
__________________________
Firm/Partnership Name
_____________________________________
Address, City, State, Zip Code
__________________
No. Yrs/Mos
__________________
Tax ID Number
__________________________
Firm/Partnership Name
_____________________________________
Address, City, State, Zip Code
__________________
No. Yrs/Mos
(attach additional page, if necessary)
2
File No.: ____________________
FORMER MARRIAGE(S)
Please complete the following: OR If no former marriages, indicate “NONE” ____________________
Name of former wife: ___________________________________________________________________________________________
Deceased Divorced Date: ___________________________ Where: ________________________________
Name of former husband: _______________________________________________________________________________________
Deceased Divorced Date: ___________________________ Where: ________________________________
(attach additional page, if necessary)
CHILDREN
_______________________________
Name
__________________
Date of Birth
_______________________________
Name
__________________
Date of Birth
_______________________________
Name
__________________
Date of Birth
_______________________________
Name
__________________
Date of Birth
(attach additional page, if necessary)
Have you ever owned a boat, airplane or any licensed vehicle (other than a car)? No Yes
If yes, describe vehicle: __________________________________________________ License Number: _________________
Have you ever filed bankruptcy? No Yes
If yes, where: County ___________________________________________________ State: __________________________
Is any portion of the new loan funds to be used for construction? No Yes
I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT:
Signature: ________________________________________ Spouse’s Signature: ________________________________________
Home
Phone __________________________
Bus
Phone ____________________________
Spouse’s
Bus Phone _________________________

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