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SE SIDE BEFORE COMPLETING FORM) TO BE COMPLETED BY MEMBER MEMBER'S NAME FIRST - LAST MEMBER'S ADDRESS (NUMBER, STREET) SOCIAL SECURITY NUMBER CITY STATE ZIP CODE TO BE COMPLETED BY ATTORNEY TAX ID# NAME OF ATTORNEY (OR LAW FIRM) ADDRESS (NUMBER, STREET) CITY STATE ZIP CODE LOCATION OF PROPERTY DATE OF CLOSING DATE OF CONTRACT ATTORNEY'S FEE FOR TRANSACTION TYPE OF TRANSACTION SALE PURCHASE COPY OF THE CLOSING STATEMENT MUST BE ATTACHED TO THIS FORM I hereby certify that this.

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