Title Insurance Application

NORTHERN ABSTRACT AND TITLE AGENCY

             Date -- mm/dd/yy                     Date Wanted -- mm/dd/yy

            Please issue a:   COMMITMENT    POLICY

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AMOUNT OF INSURANCE

         Purchase Price

          Alta Mortgage Policy without standard exceptions (survey required)

         Alta Mortgage Policy with standard exceptions (survey not required)

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AMOUNT OF PREMIUM

Purchase Price

Alta Mortgage Policy without standard exceptions (survey required) 

Alta Mortgage Policy with standard exceptions (survey not required)

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PARTY TO BE INSURED

OWNER'S POLICY

MORTGAGE POLICY

BORROWERS NAME

       TRANSACTIONS WILL BE                Deed to Insured Land Contract Home Equity New Mortgage Second Mortgage

       If refi., show liber & page of mortgage(s) being discharged.

       Liber Page

       Liber Page

        TAXES/PROPERTY TYPE

       Taxes Yes No            Date ordered -- mm/dd/yy     Commercial   Residential     Other

       ADDITIONAL INSTRUCTION

        New Construction coverage  Yes No                 Number of draws
       General Contractor

       EXISTING RIGHTS

       Present owner

       Other outstanding interests

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DESCRIPTION OF REAL ESTATE

       Land in the city, village, township of county

       Described as

        Title Insurance Yes No
                                                                                    File no.
                                                                                    Abstract Yes No

       Liber    Page

       Charge to:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail

       Copy To:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail

       Applicant