Select a Closer * SELECTDebbie Berg/Apple ValleyTara Glad/Apple ValleyKaren Johnson/Apple ValleyPatty Kosec/HastingsJennifer Laumeyer/HastingsLee Sieben/MinneapolisJackie Tix/RosevilleKimberly White/Mendota Heights
Transaction Type SELECTSellingBuyingRefinancing
Name (1) *
Marital Status SELECTSingleMarriedSeparatedDivorcedWidowed
Social Security Number/Tax ID
Place of Employment
Including loans, mortgages, home equity loans lines of credit (including accounts with zero balance or loans relating to this property). Skip if buying a property.
Do you plan on making this month's mortgage payment? SELECTYesNo
If yes, when?
Please fill in if you belong to a homeowners association. This is only required from the sellers of a property.
Do you plan on making this month's association dues? SELECTYesNo
Please answer to the best of your knowledge (while you have had an interest in the property or signed the purchase agreement). Items may affect title.
Have you filed bankruptcy or is there bankruptcy in process now? SELECTYesNo
If yes, year discharged
Has there been or will there be any changes in your marital status before closing (ie., marriage, separation, divorce)? SELECTYesNo
Are there any current or pending Judgements, Federal, State or County tax liens filed against you? SELECTYesNo
Are you aware of any recent work or improvements done to the property within the last 180 days? SELECTYesNo
Have you received medical assistance from the State of MN or any County medical assistance agency, that could result in a Medical Assistance Lien to be filed on your property? SELECTYesNo
Will there be any renters or tenants in the property as of the day of closing? SELECTYesNo
Are there any unrecording contracts, leases or other agreements related to the property? SELECTYesNo
Are you aware of any wells, including sealed/capped well on the property?NOTE: A capped well is not a sealed well. If the well is capped, please contact your real estate agent to make sure property disclosure of the well has been provided to the purchaser(s). SELECTYesNo
If you purchased the property prior to 1990, has there been any changes in the status or number of wells since you purchased? SELECTYesNo
Are there any encroachments or boundary line questions? SELECTYesNo
Any shared driveways, lack of access or party walls? SELECTYesNo
Will you be purchasing this property or hold title to this property as a corporation, Partnership, Limited Liability Company, Estate, Conservatorship, Guardianship, or a Trustees of the Trust? SELECTYesNo
Do you have a disability or need special accommodations? SELECTYesNo
If you answered yes to any of the questions above, please explain
Last 10 years of residence (address and number of years), staring with most current *
Are you a United States Citizen of legal age? SELECTYesNo
Are you currently or will you be occupying this property? SELECTYesNo