The document is a fillable request form from USA National Title Company used in an escrow transaction. It asks the seller to provide detailed information about any existing mortgages or loans on the property (first and second loan details, unpaid balances, impound status, and line‑of‑credit status), disclose any additional encumbrances such as third trust deeds, pool loans, home‑improvement loans, or liens, and supply lienholder contact information. The form also gathers data on any community association involvement, including association names, dues, management company details, and whether governing documents (CC&Rs, bylaws, budgets, etc.) are available. If the seller holds water‑stock shares, the water company name and address are requested. A forwarding address for post‑closing mail is required. The seller must certify the accuracy of the information, authorize USA National Title Company to obtain related documents and freeze any equity line of credit, and provide signatures. An instruction to fax the completed form promptly to a specified fax number is included to expedite processing.
Topics
Seller Loan Information Collection
Fields requesting first and second loan details: lender name, address, loan number, unpaid balance, phone number, and impound/line‑of‑credit status.
Additional Encumbrance Disclosure
Checkboxes and fields for third trust deed, pool loan, home‑improvement loan, or lien, plus lienholder name, address, account number, and balance.
Community Association Details
Requests for association names, dues amounts, management company information, and confirmation of availability of governing documents (CC&Rs, bylaws, budgets, etc.).
Water Stock Ownership Information
Fields to capture the name and address of the water company if the seller holds water‑stock shares.
Authorization, Certification, and Signatures
Seller certification of truthfulness, authorization for the title company to obtain documents and freeze equity lines, and multiple signature lines.
Expedited Processing Instructions
Guidance to complete, sign, and fax the form promptly to a provided fax number to speed escrow processing.