Clear Title Agency of New York, Corp.
282 N. Central Avenue
Valley Stream, NY 11580
(516) 612-4868
Facsimile (516) 612-4870
*Fax or Email to Cleartitleofny@aol.com*
Application for Title Search/Insurance
Date: ____________ Title No. _CTANY_____________
Applicant:_________________________________________________________________
Telephone:_______________________ Fax:_____________________
Transaction Is:
Purchase Price:__$____________ Mortgage:________________
Refinance:___________ Other:____________________________________________
Premises: _________________________________________________________
Tax Map District:_________ County:____________ Block: _____Lot(s): ____
Survey Requirements (check one):
__Order X_Copy Attached __Locate __Survey not needed
__Bank will accept Survey Endorsement __Obtain Survey From__________
Municpal Searches (check):
__Certificate of Occupancy __Housing &Bldg. __Fire Dept. _Emergency Repairs
__Tax & Vault __Street/Highway __Bankruptcy __Sewer
Notes/
Sp. Inspection:_______________________________________________________________________
Owner/Seller:___________ Owner Atty:__________________________________
S.S./Fed ID: _____________________ Address: ____________________________________
Phone:_______________ Fax:_____________________
Purchaser:___________________ P’s Atty:_____________________________________
S.S./Fed ID____________________ Address:____________________________________
Purchaser:___________________ Phone:______________Fax:__________________
S.S./Fed ID___________________
Needed By: