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MAP NUMBER <br /> <br />NEW OWNER'S NAME <br /> <br />ADDRESS <br /> <br />SUBDIVISION <br />Lot l~lock <br /> <br /> SEGREGATION <br />DEED/S <br /> <br />ACREAGE <br />Are improvements on new <br />parcel? YES NO <br />Survey? YES NO <br />Are taxes <br />current? YES NO <br /> <br />REQUEST TAKEN BY <br />( Additional <br /> <br />remarks on back~/// <br /> <br /> COMBINATION <br />Are ,at} names :identical <br />on each account? <br />Does ~ortgage include <br />alll accounts? <br />Are all accounts <br /> <br />YES <br />YESI~NO <br />YES'NO' <br /> <br />contiguous? <br /> <br /> DATE ~ <br /> TELEPHONE~ N~UMBER <br /> <br /> <br />