The Landmark Team You can trust Miami Valley's top-ranking title insurance & settlement agency Seller Information Sheet 280 Regency Ridge Drive • Dayton, Ohio 45459 • 937.432.6300 • Fax: 937.432.6075 • 800.660.5284 • landmarktitlesouth.com Today's date (required)*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 20222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Buyer name (required)*FirstLast Contract close date (required)*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 20222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Property street address (required)* City (required)* Zip (required)* County of property being sold (required)* Agent name (required)*FirstLast Agent Email (required)* Agent mobile phone (required)* Agent fax (required)* Seller1 name (required)*FirstLast Seller1 Married?YesNo Seller1 SSN (required)* Seller1 phone (required)* Seller1 email (required)* Seller2/spouse nameFirstLast Seller2/Spouse Married?YesNo Seller2/Spouse SSN Seller2 phone Seller2 email Will seller(s) be attending the closing? (required) (IF NO, PLEASE CONTACT US ASAP TO GET ALL CONTACT INFORMATION)*YesNo 1st MortgageHolderAccount number 2nd Mortgage/Equity LineHolderAccount number Homeowner's Association (HOA) (if applicable) Association name Contact name Contact phone number Total commission? (required)* Split commission? (required)*YesNo Split % (required)* Listing broker % Selling broker % Additional commission? (required)*YesNo Additional commission amount Commission check distribution (required)*Pickup at closingMail USPSWired If AGENT not attending closing, please provide address to send check. Street Address Street Address Line 2 City State Postal / Zip Code Seller's principle residence past 2 out of last 5 years? *YesNo Will purchaser be acquiring OWNER'S TITLE INSURANCE with seller contribution of up to $300? (required)*YesNo Additional seller expenses Number verification Good Funds Law | Effective September 29, 2017The Ohio Good Funds Law requires: Any funds exceeding $10,000 must be wired to Landmark Title Agency South prior to disbursement. Cashier's Checks will be accepted under $10,000. A personal check will be accepted under $1,000. ACH transfers are not accepted. For wiring instructions, please contact Nancy Barnes by email nbarnes@landmarktitlesouth.com or FAX 937.432.6075. I consent collecting this data and processing it according to Privacy Policy of this website.SubmitReset Hire the trusted Landmark Team today! Contact
