PA Record Owner and Lien Certificate 1

Order No.:

Effective Date: _______________

Premises: (Show completed address with House #, City and/or Township, County, State and Tax Parcel #'s, if applicable)

Based upon the examination of evidence in the appropriate public records, Company certifies that the premises endorsed hereon are subject to the liens, encumbrances and exceptions to title hereinafter set forth. This Certificate does not constitute title insurance; liability hereunder if assumed by the Company solely in its capacity as an abstractor for its negligence, mistakes or omissions in a sum not exceeding Two Thousand Dollars unless otherwise endorsed hereon.

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LEGAL DESCRIPTION

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1. RECORD OWNER:

TITLE TO SAID PREMISES IS VESTED IN ______________________________

by Deed from ________________________________________________________

dated __________________________ and recorded _______________ in Deed Book _______________ Page _______________.

ATTACHED TO AND FORMING A PART OF RECORD OWNER AND LIEN

CERTIFICATE NO. _________________

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Subject to the encumbrances and claims as follows:

2. TAXES: ACCOUNT NO. OR TAX PARCEL NO. ____________________

__________ Assessment $ ____________________

3. LIENABLE WATER AND SEWER RENTS AND/OR CHARGES BY MUNICIPALITIES:

_____________________

_____________________

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4. MECHANICS AND MUNICIPAL CLAIMS:

5. MORTGAGES:

6. JUDGMENTS:

7. BANKRUPTCIES:

8. REQUIREMENTS/EXCEPTIONS:

NOTE:

The status or validity of title to the subject premises may be affected by matters disclosed by survey, rights of parties in possession and other items not found of record and not certified hereon. Therefore, the Applicant is cautioned against using this Certificate as a basis for consummating a real estate transaction, until this Certificate is converted in a Title Report, Binder or Commitment at which time additional exceptions and settlement requirements will be added.

Settlement or the removal of items and exceptions will not be made on this Certificate. This Certificate may be converted into a report for title insurance at any time. If the conversion is made within six months from the date hereof, credit will be allowed against the fee previously paid.

No guidelines are available for this form at this time.