Real Estate Ownership Form

REAL ESTATE OWNERSHIP FORM

Property Identification

Property Address:

Owner(s) Information

Owner 1 Full Legal Name:

Owner 1 Phone:    Owner 1 Email:

Owner 2 Full Legal Name:

Owner 2 Phone:    Owner 2 Email:

Vesting and Ownership Interests

Select vesting / tenancy type (select all that apply):
Sole Owner   Joint Tenants   Tenancy in Common   Community Property
Held in Trust   Corporation / LLC   Other:

Percentage interest Owner 1:    Percentage interest Owner 2:

Effective Date of Ownership:

Encumbrances, Mortgages, and Taxes

Are property taxes delinquent? Yes No

Occupancy and Use

Current occupancy status: Owner-occupied Tenant-occupied Vacant

Disclosures

For each item below, mark the applicable box and provide explanation where required.

Lead-based paint known or suspected? Yes No

Past or current mold issues? Yes No

Structural damage, fire, flood, or material repair history? Yes No

Pending litigation, foreclosure, or bankruptcy affecting the property? Yes No

Prior Transfers and Title Matters

Have any transfers affecting title to the property occurred within the last five years? Yes No

Certification and Acknowledgment

By signing below, Owner(s) certify under penalty of perjury that the information provided in this form is true, correct and complete to the best of their knowledge. Owner(s) represent and warrant that they hold the ownership interest stated above, that there are no undisclosed encumbrances or agreements that would materially impair the ability to transfer the stated interest, and that they will promptly notify the recipient of any change to the matters disclosed herein prior to any conveyance or recording.

Owner(s) agree to indemnify, defend and hold harmless any purchaser, title company, or lender who relies on this certification from losses resulting from any material misrepresentation or omission contained in this form, except to the extent caused by the indemnitee's own gross negligence or willful misconduct.

This form is a declaration of ownership facts and is not, by itself, a conveyance instrument. Any transfer of any interest in the described property requires a separate executed and recordable deed or instrument, and recording of such instrument may be required to effect the transfer.

Governing Law: The interpretation and enforcement of this form shall be governed by the laws of the state of without regard to conflict of law principles.

Entire Agreement: This form constitutes the entire written statement of ownership and supersedes all prior written statements by the undersigned relating to the matters addressed herein.

Optional Notary Acknowledgment

A notary acknowledgment may be attached and recorded if required by local recording authorities. Provide notary acknowledgment or additional notarization details here:

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