Lien Verification Form
City Taxes Paid?
Please Select
Yes
No
N/A
Amount of Taxes Paid and Date Paid:
Name And City Telephone Number:
County Taxes Paid?
Please Select
Yes
No
Not Sure
Amount of Taxes Paid and Date Paid:
Name And County Telephone Number:
Water/Sewer Bill Paid?
Please Select
Yes
No
Not Sure
Amount Paid and Date Paid:
Name And Water Company Telephone Number:
HOA (Homeowners Association) Dues Up To Date?
Please Select
Yes
No
N/A
Amount Paid and Date Paid:
Name And Telephone Number for HOA:
Email Address for HOA:
Are there any other liens that may be reported against you as the homeowner, or any known liens against the property you are submitting for review? This included charged off Credit Cards and other personal loans.
Company:
Telephone Number:
Amount of Lien:
Company:
Telephone Number:
Amount of Lien:
Company:
Telephone Number:
Amount of Lien:
I have called all the proper authorities and the above information has been verified as correct. I am aware that if I neglect to properly research and disclose this information, I may be responsible for bringing money to the closing to pay for any undisclosed liens on my property.
I type my name below to acknowledge the above statement:
Submit
Should be Empty: