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2. Parcel ID#*
3. NBHD#*
4. APR*
   -- Select One --AWC1C2CNKCTBDTMMWSEWW
5. QTR*
7. 1.) Type of sale*

   Please choose one

   1. Residential
   2. Commercial
   3. Vacant
   4. Farm
   5. Other
   6. Multi-Parcels
9. 2.) Sales/Purchase Price*
11. Was there Personal Property Included?*

    1. Yes
    2. No
12. If yes, what is the value of the Personal Property?
13. What type of Personal Property was included? (ex. furniture)
15. 3.) Do you consider the sale price a fair market price?*

    1. Yes
    2. No
16. If no, what would you consider to be a fair market price?
18. 4.) Was this sale any of the following:
20. a.) a transfer between relatives?

    1. Yes
    2. No
21. b.) to correct defective title?

    1. Yes
    2. No
22. c.) Forced sale (e.g. forclosure, estate or court order)

    1. Yes
    2. No
24. 5.) Has there been any improvement added or removed?

    1. Yes
    2. No
26. If you answered yes to the question above, please explain in the space below:
28. 6.) If residence, please complete the section below:
30. Number of Bedrooms
31. Full Baths
32. Number of Half-Baths
34. Total Number of Rooms
    (this number includes bedrooms, Kitchen, Living room etc. but excludes the bathrooms)
36. Total number of Additional Fixtures
    (Additional Fixtures are anything in addition to your standard tub, sink and toilet. Ex: extra sink or separate shower in addition to tub in bathroom. A sink in a laundry room would also count as an Additional Fixture)
38. Number of fireplaces
40. Type of Heat & Air:

    1. Central Heat & Air/Heat Pump
    2. Base Board
    3. Solar
    4. Other
    5. None
41. If you answered Other for Heat & Air, please tell us what type
43. Does the residence have a basement?

    1. Yes
    2. No
44. Is Basement:

    1. Finished (Drywall/ Heat/AC)
    2. Unfinished
45. Is Basement:

    1. Full
    2. Partial
47. If house is under construction, what is the percent complete?
49. Additional Comments
51. Phone Number*
52. Email Address*
54. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
56. Electronic Signature*
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit Submit and Print

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