—_f/ ( i Attorneys om H WS Jocqeeling M Hudhins == Wi Mtarthe L Pritlo . ; Reckek Gaeta a Dr r ' u ' 1S +O'NEI Morgan 0. Jones & Theodore P. Pritte HUDKINS TITLE & SETTLEMENT Reema 1. Marcu John P teb HUDKINS LAW. © Conde M ONeill lowe M. Teenenelis oat 7 BUYER INFORMATION PLEASE PROVIDE THE INFORMATION REQUESTED BELOW AND RETURN VIA FAX OR EMAIL. FAX: RD Ema: Address of Property to be Purchased: Sradteed OH FULLNAMEOFBuvER#: = (cavity Veolity Lic Social Security ‘a ¢ le Coot ser Le Daytime phone hi Evening phone #: For deed preparation purposes, please respond to the following: Please circle: Married or Single Will this property serve as your primary residence? N FE ER #2: Social Security Number: Daytime phone #: Evening phone #: Email Address: For deed preparation purposes, please respond to the following: Please circle: Married or Single Will this property serve as your primary residence? HOMEOWNER INSURANCE INFORMATION FOR PROPERTY TO BE PURCHASED: (ia f Insurance Company Name: V! AA ai Agent Name: Phone: : | Annual Premium: __ erin _. Policy Effective Dates: 2 2h fig ; It is the practice of ont Ww he be. title | insurance policies with the maximum coverage available. If you have questions about title insurance, please contact our firm BEDFORD, NH CONCORD, NH HAMPTON, NH KEENE, NH NEW LONDON, NH WINDHAM, NH NORWICH, VT ANDOVER, MA 264 South River Rood — Copitel Plaze, 57 North Moin Street 58 Winnocennet Rood 265 Weshingten Street 9 Newport Rood 25 Indian Rock Rd. #9 316 Main Street, Suite 201 300 Brickstone Squor 03110 Suite 104, 03301 03842 03431 PO Box 800, 03257 PO Box 719, 03087 PO Box 15, 05055 Suite 201, 01810 EFTA00089332