PLEASE COMPLETE, SIGN AND RETURN	Escrow No.:  
	Order No.:  

CONFIDENTIAL INFORMATION STATEMENT

Proper completion of this form will help protect you by enabling the title company to eliminate the problems that might arise through similarity of your name with the name of another person against whom there may be judgments, tax liens, or other matters affecting property ownership.
COMPLETION OF THIS FORM WILL EXPEDITE YOUR ORDER AND WILL HELP PROTECT YOU
	Name (1st Party)

		Name  (2nd Party)	
First	Middle	Last

	First	Middle	Last	
Date of Birth	Birthplace

	Date of Birth	Birthplace	
I have lived in	Social Security No.
California since

Home Phone                                              Business Phone	

Cell Phone 	

Driver's license #	
	I have lived in	Social Security No.
California since

Home Phone                                              Business Phone	

Cell Phone 	

Driver's license #		

ARE PARTIES 1 and 2   (    )  Married   (   )  Domestic Partners   Married on 	 at 	 Maiden Name 		

RESIDENCE(S) DURING PRECEDING 10 YEARS

	FROM	TO	
NUMBER AND STREET	CITY

	FROM	TO	
NUMBER AND STREET	CITY

	FROM	TO	
NUMBER AND STREET	CITY

	FROM	TO	
NUMBER AND STREET	CITY
(If more space is needed, use reverse side of form)
OCCUPATION (S)

1st Party	
PRESENT OCCUPATION	FIRM NAME	ADDRESS		NO. YEARS

PRIOR OCCUPATION	FIRM NAME	ADDRESS		NO. YEARS

2nd Party	
PRESENT OCCUPATION	FIRM NAME	ADDRESS		NO. YEARS

PRIOR OCCUPATION	FIRM NAME	ADDRESS		NO. YEARS
(If more space is needed, use reverse side of form)
FORMER MARRIAGE(S)/PARTNERSHIPS
If no former marriages/Domestic Partnerships, write "none"	

1st Party - Name of former Spouse/Domestic Partner	

Deceased	Divorced/Termination	When	Where	

2nd Party - Name of former Spouse/Domestic Partner	

Deceased	Divorced/Termination	When	Where	
(If more space is needed, use reverse side of form)

THE STREET ADDRESS of the property in this transaction is:  	

	IMPROVEMENT:  (  )	SINGLE RESIDENCE	(  )	MULTIPLE RESIDENCE	(  )	COMMERCIAL
	OCCUPIED BY:	(  )	OWNER	(  )	LESSEE	(  )	TENANTS
	ANY PORTION OF NEW LOAN FUNDS TO BE USED FOR CONSTRUCTION:	(  )	YES	(  )	NO

HAS ANY CONSTRUCTION OR IMPROVEMENTS BEEN MADE TO THE PROPERTY IN THIS TRANSACTION DURING THE LAST SIX MONTHS?
(  )  YES	(  )  NO

	  	
	SIGNATURE	SIGNATURE

	DATE	DATE

Email 		Email