Goggans, Stutzman, Hudson, Wilson, and Mize, LLP.

Address of Property being Sold:(Required)

Street Address Address Line 2 City State ZIP Code

The Seller is:(Required)

An Individual(s)

An Entity (Corporation, LLC, Trust)

An Estate (Please note all proceeds will be made payable to the Estate)

An Estate

Name of Estate(Required)

EIN(Required)

Seller Number One

Name- Seller One(Required)

First Last

Social Security Number- Seller One(Required)

Email- Seller One(Required)

Phone- Seller One(Required)

Do you have a Seller Number Two?(Required)

Seller Number Two

Name- Seller Two(Required)

First Last

Social Security Number- Seller Two(Required)

Email- Seller Two(Required)

Phone- Seller Two(Required)

An Entity (Corporation, LLC, Trust)

Name of Entity(Required)

EIN / Tax ID Number(Required)

Name of Representative Attending Closing(Required)

We must receive the signer’s proof of authority to sign on behalf of the entity prior to the closing. Please send the entity’s Operating Agreement, By-Laws or Resolution for review as soon as possible.

First Last Title

Representative Email(Required)

Representative Phone(Required)

Additional Information

Forwarding Address

If unavailable currently, please provide before closing.

Street Address Address Line 2 City State ZIP Code

Is the Seller a Georgia Resident?(Required)

Yes

Was the property your primary residence for two of the last five years?(Required)

Yes

Is the Seller a U.S. Citizen or possess Permanent Resident status?(Required)

Yes

(If not, you may be subject to US withholding tax).

Seller Information Form

An Estate

Seller Number One

Seller Number Two

An Entity (Corporation, LLC, Trust)

Additional Information

Water Service

Loan Payoffs

First Mortgage Lender

Second Mortgage Lender

Home Equity Lender

Homeowners Association

Final Information