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Name of Loan Applicant:		Co-Applicant:
Phone:		Cell / Other #:
Property Address:
City:
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Zip Code:
Type of Property:	1004 ( URAR ) URAR ( Agricultural ) 2055 2065 Vacant Land Narrative Certificate of Completion Recertification of Value
Legal Description or ID Number
Current Owner ( If Sale):		Phone #:
Appraisal Type:	1004 ( URAR ) URAR ( Agricultural ) 2055 2065 Vacant Land Narrative Certificate of Completion Recertification of Value
Special Instructions
Listing Agent ( If Known):
Agent Phone:
Lender Information
Officer / Processor Name:
Phone:
Company Name:
Address:
E-Mail:
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