STATEMENT OF IDENTITY - Chicago Title Premier …

1 STATEMENTOFIDENTITYF orconfidentialusebyChicagoTitleCompanyon lyin tobecompletedandSI GNEDPERSONALLY byea chpa rtytothetransactionandbyBOTHHUSBANDANDWI FE, beforepo licyofin surancecanbe wr necessary becausewehavebeenaskedtoinsure a titletore al pr operty in whichyo u ar e int searchingyourtit le wemayencounterjudgements,ba nkruptcies,divorces,andincome-taxliensag ainstpersonswith herwisecloudthetitletothisproperty if youwillhelpus byCOMPLETELY filling inthefollowingsta I HAVE LIVEDCONTINUOUSLYINTHEUSASINCE_____BUSIN ESSPHONE_____ ___HOMEPHONE_____DRIVER SLICENSENO. _____ _____(IFMARRIED,COMPLETETHEFOLLOWING) I HAVE LIVEDCONTINUOUSLYINTHEUSASINCE_____BUSIN ESSPHONE_____ ___HOMEPHONE_____DRIVER SLICENSENO. _____ _____WEWEREMARRIEDON_____ AT_____WIFE SMAIDENNAME_____ _____-- --- ----------------------- --- --- --- -- --- ------------- ---------------------------------------- --------- --- --- --- --- --- --- ------ -- --- --- --- --- --- --- --- --- --- ---RESIDENCES_____OCCUPATIONS(HUSBAND S)_____(WIFE S)_____(If morespaceis needed,usereversesideof form.)

2 ----------------------------------- --- ---------------------------------------- ---------------------------------------- ------------ -----------IFNO FORMERMARRIAGES,WRITE NONE _____OTHERWISE,PLEASECOMPLETETHEFOLLOWIN G:NAMEOFFORMERWIFE_____Deceased_____Divo rced____When_____Where_____NAMEOFFORMERH USBAND_____Deceased_____Divorced____When _____Where_____(Ifmorespaceisneeded,user e versesideofform)------------------------ ----------- --- ---------------------------------------- ---------------------------------------- ------------ ----------CHILDRENBYCURRENTORPREVIOUSMAR RIAGEADDITIONAL CHILDREN(if applicable)NAME_____BIRTHDATE_____NAME__ ___BIRTHDATE_____NAME_____BIRTHDATE_____ -- --- ----------------------- --- ------------------------------------ -------------------------------- --- ------------------------- ---- ----------------------------(Fullmiddle name-if none,indicate)(First Name)(LastName)(Fir st Name)(Fullmiddlename-if none,indicate)(LastName)(Date)(Place)Num berandStreetCityFrom(Date)To (Date)

3 NumberandStreetCityFrom(D ate)To (Date)FirmNameLocatio nFirmNameLocationFirmNameFirmNameLocatio nLocationBuyerintendsto reside onthepropertyin th no (Ifmorespaceis needed,usereversesideof form)___ _____ _____ _____THISPORTIONTOBE COMPLETEDBYTHESELLER (INCLUDINGABOVEPORTIONS)TheStreet Addressof thepr opertyin thistransactionis_____ _____Thelandis unimproved ; orimprovedwitha str uctureof thefo llowingtype;a Single or 1 to 4 Family ; a CondominiumUnit ; Ot her Improvements,remodelingorrepairsto thispropertyhavebeenmade wi thinthepa st s no If yes,haveall costsforla borandmaterialsarisingin connectiontherewithbe enpa id in full?ye s no ___ _____TheUnders ig neddeclar e,underpenaltyofperjury,thattheforegoing is cuted on_____, at_____Signature:_____Spouses Signature:_____(leaveblankif none)TE 80 LEGAL2PT(7/94)