PENINSULA SETTLEMENTS, LLC SELLER INFORMATION FORM

PENINSULA SETTLEMENTS, LLC
SELLER INFORMATION FORM
Client Name:
___________________________________________
Property Address:
______________________________________________
______________________________________________
PLEASE RETURN YOUR COMPLETED FORM TO:
PENINSULA SETTLEMENTS
20 Courthouse Square
Suite 213
Rockville, Maryland 20850
FAX: (301) 444-4666
Authorization to Order Mortgage Payoff
Please provide information regarding all mortgages secured by your property.
Property Address: __________________________________________________________________
Name of Bank or Mortgage Company to be paid off is:
Name:
Phone #:
Address (Customer Service address not P.O. Box where you send monthly payments):
Account #:
Name of Bank or Mortgage Company to be paid off is: SECOND MORTGAGE (if
applicable)
Name:
Phone #:
Address (Customer Service address not P.O. Box where you send monthly payments):
Account #:
Social Security Number(s)
_______________
Please release payoff information to Peninsula Settlements, LLC, Gaithersburg, MD
20878.
Seller
Seller
HOA/CONDOMINIUM ASSOCIATION
IF YOUR PROPERTY IS SUBJECT TO A HOA/CONDOMINIUM ASSOCIATION,
PLEASE PROVIDE THE FOLLOWING INFORMATION, OTHERWISE CHECK THE
N/A BOX BELOW:
_____ Not Applicable/Property not subject to HOA/Condo Association.
Name of Seller:
Name of HOA/Condominium Association:
Mailing Address:
Telephone Number:
Amount of Assessments/Payment Frequency (Monthly/Quarterly/Annually):
HOA Fees are Paid Through the Following Date:
Is your property subject to a private front foot benefit charge or private utility company
charge? If so, please provide details and contact information.
WATER/SEWER INFORMATION
Water Service Provider:
________________________________________________
Account No.:
________________________________________________
Provider’s Phone:
________________________________________________
Date Contacted:
_________________________
Sewer Service Provider:
________________________________________________
Account No.:
________________________________________________
Provider’s Phone:
________________________________________________
Date Contacted:
_________________________
If Property is in City of Rockville, does City provide water or refuse service?
Yes
_____
No
_____
N/A
_____
FINAL WATER/SEWER BILLS SHOULD BE SENT TO:
Peninsula Settlements
20 Courthouse Square
Suite 213
Rockville, MD 20850
(301) 444-4660
SELLER INFORMATION
RESIDENCY INFORMATION/MARYLAND WITHHOLDING TAX
[For Maryland properties] Is each Seller a resident of the State of Maryland?
____ Yes
_____ No
If “No”, which Sellers are not Maryland residents?
____________________________________________________
Non-residents are subject to Maryland Withholding Tax. This tax is collected at closing.
In 2011, the tax rate for individuals is 6.75% and for business entities 8.25%. The tax is
based on the net proceeds received at closing. For more information, visit
http://individuals.marylandtaxes.com/estatetax/withholding.asp.
FORWARDING ADDRESS INFORMATION (POST-SALE)
Name:
_____________________________________________
Address:
_____________________________________________
City/State/Zip:
_____________________________________________
Phone:
_____________________________________________
SELLER(S)’ SOCIAL SECURITY NUMBERS
Name/SSN:
_____________________________________________
Name/SSN:
_____________________________________________
Name/SSN:
_____________________________________________
RENT BACK
Will there be a rent back agreement? Yes _____
No
_____
If “Yes”, until when will you be renting back the property?
______________________________________________________.
CLOSING CREDIT
Are you giving the Buyer(s) a closing credit?
If “Yes”, how much is the closing credit?
Yes _____
No _____
_________________________.
U.S. WITHHOLDING TAXES
Are any of the sellers non-U.S. citizens, subject to tax withholding?
_____ Yes
_____ No
INVESTMENT PROPERTY
Was the property your principal residence? _____ Yes
_____ No
If not, does the property have tenants?
_____ No
_____ Yes
WIRE REQUEST
Do you want your proceeds wired to you?
_____ Yes
_____ No
If yes, a $25.00 wire fee will be charged. We will also need to receive wiring instructions
from you.
CONTACT INFORMATION
Phone Numbers:
E-Mail:
(w)
_________________________________
(c)
_________________________________
(h)
_________________________________
_________________________________
MISCELLANEOUS ISSUES
If there is anything you would like us to know in advance of the settlement, please use
this space: