Purchaser Qualification Form | Clinton County Land Bank

Contact Information

Name OR Company/Organization Name

Phone Number

Address

City

State/Province

Zip/Postal

Country

Property Information

Parcel Number *

Address *

Address

City

State/Province

Zip/Postal

Country

Are property taxes paid in full?

Yes

No

Any outstanding code violations?

Yes

No

Add Remove

Parcel Number *

Address *

Address

City

State/Province

Zip/Postal

Country

Are property taxes paid in full?

Yes

No

Any outstanding code violations?

Yes

No

Please list current use of property.

Have you (individual/company/organizations) owned property that has been foreclosed upon for delinquent taxes?

Yes, if so please provide parcel number(s) and year of foreclosureYes, if so please provide parcel number(s) and year of foreclosure

No

Have you (individual/company/organization) owned property that has been the subject of a mortgage foreclosure?

Yes, if so please provide parcel number(s) and year of foreclosureYes, if so please provide parcel number(s) and year of foreclosure

No

If a company or organization, please describe your work:

By selecting "I Accept" using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. *

I Accept

E-Signature *

Date

reCAPTCHA