Statement Of Information Form

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STEWART TITLE OF CALIFORNIA, INC.
STATEMENT OF INFORMATION
CONFIDENTIAL INFORMATION STATEMENT TO BE USED IN CONNECTION WITH ORDER NO:
COMPLETION OF THIS FORM WILL EXPEDITE YOUR ORDER AND WILL HELP PROTECT YOU.
THE STREET ADDRESS of the property in this transaction is:
IF NONE LEAVE BLANK
____________________________________________
___________________________________________________
ADDRESS
CITY
IMPROVEMENTS:
SINGLE RESIDENCE
MULTIPLE RESIDENCE
COMMERCIAL
OCCUPIED BY:
OWNER
LESSEE
TENANTS
ANY PORTION OF NEW LOAN FUNDS TO BE USED FOR CONSTRUCTION
YES
NO
NAME
SPOUSES NAME
_________________________________________________________
________________________________________________________
FIRST
MIDDLE
LAST
FIRST
MIDDLE
LAST
____________________________
_________________________
____________________________
________________________
BIRTHPLACE
BIRTH DATE
BIRTHPLACE
BIRTH DATE
______________________________
_________________________
_____________________________
________________________
I HAVE LIVED IN CALIFORNIA SINCE
SOCIAL SECURITY NUMBER
I HAVE LIVED IN CALIFORNIA SINCE
SOCIAL SECURITY NUMBER
. _______________________________________
_____________________________________
DRIVER'S LICENSE NO
DRIVER'S LICENSE NO.
________________________________________
WIFE'S MAIDEN NAME
_______________________________________
______________________________________________________
WE WERE MARRIED ON
AT
RESIDENCE(S) FOR LAST 10 YEARS
_________________________________________________________________________________________________________________________
NUMBER AND STREET
CITY
FROM
TO
_________________________________________________________________________________________________________________________
NUMBER AND STREET
CITY
FROM
TO
_________________________________________________________________________________________________________________________
NUMBER AND STREET
CITY
FROM
TO
_________________________________________________________________________________________________________________________
NUMBER AND STREET
CITY
FROM
TO
OCCUPATION(S) FOR LAST 10 YEARS
HUSBAND
___________________________________________________________________________________________________________________
PRESENT OCCUPATION
FIRM NAME
ADDRESS
NO. OF YEARS
_________________________________________________________________________________________________________________________
PRIOR OCCUPATION
FIRM NAME
ADDRESS
NO. OF YEARS
_________________________________________________________________________________________________________________________
PRIOR OCCUPATION
FIRM NAME
ADDRESS
NO. OF YEARS
WIFE
_______________________________________________________________________________________________________________________
PRESENT OCCUPATION
FIRM NAME
ADDRESS
NO. OF YEARS
_________________________________________________________________________________________________________________________
PRIOR OCCUPATION
FIRM NAME
ADDRESS
NO. OF YEARS
_________________________________________________________________________________________________________________________
PRIOR OCCUPATION
FIRM NAME
ADDRESS
NO. OF YEARS
:
FORMER MARRIAGES
IF NO FORMER MARRIAGES, WRITE "NONE" ___________________
NAME OF FORMER SPOUSE _____________________________________
________________________________________________________
IF DECEASED:
DATE ________________________________
WHERE _____________________
CURRENT LOAN ON PROPERTY
PAYMENTS ARE BEING MADE TO:
2. ______________________________________________________
1. ________________________________________________________
3. ______________________________________________________
HOMEOWNERS ASSOCIATION
______________________________________
NUMBER (
) ________________________________
DATE__________________________ SIGNATURE ________________________________________________________________________
HOME PHONE ___________________________ BUSINESS PHONE ___________________________
DOCUMENT PROVIDED BY STEWART TITLE OF CALIFORNIA, INC.
SIENGLSH.DOC

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