STEWART TITLE GUARANTY COMPANY
STATEMENT OF INFORMATION
CONFIDENTIAL - TO BE USED ONLY IN CONNECTION WITH ORDER NO:
_____________________
NOTE: THIS FORM IS NEEDED IN
ORDER TO ELIMINATE JUDGMENTS AND LIENS AGAINST PEOPLE WITH SIMILAR NAMES
THE STREET ADDRESS
of the property in this transaction is:
(IF NONE
LEAVE BLANK)
ADDRESS ____________________________________________ CITY __________________________________________________
· ANY CONSTRUCTION OR IMPROVEMENTS WITHIN THE LAST 6 MONTHS? YES NO
· IF YES, STATE NATURE WORK DONE:
____________________________________________________________________________________
PARTY 1 PARTY
2
___________________________________________________________________ ________________________________________________________________
FIRST MIDDLE LAST FIRST MIDDLE LAST
___________________________________________________________________ ________________________________________________________________
FORMER
LAST NAME(S), IF ANY FORMER
LAST NAME(S), IF ANY
_________________________________ _____________________________ _________________________________ ___________________________
BIRTHPLACE BIRTH
DATE BIRTHPLACE BIRTH
DATE
_________________________________ _____________________________ _________________________________ ___________________________
SOCIAL
SECURITY NUMBER DRIVER'S
LICENSE NO. SOCIAL
SECURITY NUMBER DRIVER'S
LICENSE NO.
I AM SINGLE
AM MARRIED
HAVE A DOMESTIC PARTNER
I AM SINGLE
AM MARRIED
HAVE A DOMESTIC PARTNER
NAME
OF CURRENT SPOUSE OR DOM. PARTNER (if other than Party 2): NAME OF CURRENT
SPOUSE OR DOM. PARTNER (if other than Party 1):
___________________________________________________________________ ________________________________________________________________
NAME
OF FORMER SPOUSE/DOM. PARTNER: (IF NONE, WRITE “NONE”): NAME OF FORMER
SPOUSE/DOM. PARTNER: (IF NONE, WRITE “NONE”):
___________________________________________________________________ ________________________________________________________________
MARRIAGE
OR DOMESTIC PARTNERSHIP BETWEEN PARTIES 1 AND 2
ARE PARTIES 1 & 2:
MARRIED?_______ DOMESTIC
PARTNERS?_______ DATE OF MARRIAGE/DOM.
PARTNERSHIP: _________________
PARTY 1 - OCCUPATIONS FOR LAST 10 YEARS
________________________________________________________________________________________________________________________
PRESENT OCCUPATION FIRM
NAME ADDRESS NO.
OF YEARS
________________________________________________________________________________________________________________________
PRIOR OCCUPATION FIRM
NAME ADDRESS NO. OF YEARS
PARTY 1 - RESIDENCES
FOR LAST 10 YEARS
NUMBER AND STREET CITY
and STATE FROM TO
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
PARTY 2 - OCCUPATIONS FOR LAST 10 YEARS
________________________________________________________________________________________________________________________
PRESENT OCCUPATION FIRM
NAME ADDRESS NO.
OF YEARS
________________________________________________________________________________________________________________________
PRIOR OCCUPATION FIRM
NAME ADDRESS NO.
OF YEARS
PARTY 2 - RESIDENCES
FOR LAST 10 YEARS (If
same as Party 1, write “same”)
NUMBER AND STREET CITY
and STATE FROM TO
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
DATE
_________________________ HOME PHONE
____________________________ BUSINESS
PHONE ___________________________
SIGNATURES
___________________________________________________
___________________________________________________
REV.
6/1/04