Midwest Title and Escrow Jefferson City, MO

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Closer: Kaleb

Seller's First Name

Seller's Last Name

What is the address of the property you are selling?

Marital Status:

Spouses Name (if applicable)

Are all sellers US citizens?

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Please Note: Your spouse will be required to sign the Warranty Deed at or before closing.

Is property in a neighborhood with an active Home Owners Association?

Yes

No

If yes, please type the amount of HOA dues and the frequency they are paid (yr,qtr,mo). Please type "NONE" if this does not apply.

If you do pay HOA dues, are they paid to current?

Yes

No

N/A

Name & Phone number/email of the person who collects HOA dues.

Are you aware of any neighborhood improvements pending in your area, which you will be billed for?

Yes

No

Is there a propane tank?

Yes

No

How many years old is the home?

Has the home had over $5,000 in remodeling done in the last 6 months?

Yes

No

Do you owe money for any outstanding invoices for repairs completed on this home?

Yes

No

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Outstanding Invoice Note

Note: All bills for repairs must be paid from the closing or prior to it. Bring paid receipts for any repairs over $100.

Have you been contacted by the City or County regarding ANY code violations?

Yes

No

Are you aware of any violations of restrictive covenants or boundary line issues that may affect this property?

Yes

No

Do you access your property off a public road or private road?

Public

Private

How many loans/mortgages do you have on this property?

Who is your Lender?

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Please do not draw on any line of credit loans within 15 days of closing.

Review the following list and check all that apply:

You have an open bankruptcy proceeding

You have a State or Federal tax lien or levy

You are party to an open lawsuit

Someone has questioned or challenged your ownership of the property

You have been notified of a possible encroachment over your lot lines

You are delinquent on your county Real Estate taxes

You have divorced since you acquired the property

You share a driveway with a neighbor

You pay for road maintenance

Are you, or an immediate family member, a “Judicial Officer”, as defined by RSMo § 476.1300? (i.e.: a justice, judge, commissioner, magistrate, prosecuting attorney, and circuit attorney at all levels of the Court System in both State and Federal Courts)? Or have you ever qualified to have any County court records or public records (at the County Recorder’s Office) redacted or shielded from public view?

Yes

No

If you have divorced since acquiring the property, was your spouse awarded a money judgement again you and/or the home's equity?

Yes

No

N/A

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Note: you will be contacted for additional details by your title company closer.

Phone number can contact you at with questions regarding your answers.

Name of person completing this form

Date of Closing

Will you or your spouse be attending closing?

Yes

No

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If you have selected no you or your agent MUST make arrangements with our office to pre-sign your documents before closing.

Is there any additional information you'd like to send to the title company? If so, please comment below.

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Please select the closer below (there will only be one option)

Closer

Seller Questionnaire Form - Kaleb

Seller Questionnaire - Kaleb