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?
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: