Your Information

First Name

Please provide your first name

Last Name

Please provide your last name

Phone Number

Please provide your phone number

Email

Please provide your email address

QCD Form

Property Address

Enter the property address

City, State

Enter the city and state of the property address

Grantor(s) Full Legal Name(s)

Enter the grantor(s)/seller(s) full legal name

Grantor(s) Mailing Address

Enter the grantor(s)/seller(s) mailing address

(Check One)

Grantee(s) Full Legal Name(s)

Enter the grantee(s)/buyer(s) full legal name(s)

Grantee(s) Mailing Address

Enter the grantee(s)/buyer(s) mailing address

(Check One)

Homestead

Enter the information regarding the homestead

(Check One)

Mortgage Balance

Is there currently a mortgage balance on this property? If so, please provide the current mortgage amount owed. In Florida, a Documentary stamp tax is applicable to mortgages, liens, or other evidence of indebtedness filed or recorded. The tax rate is $.35 per $100 (or portion thereof), based on the secured amount. Additional charges will apply.

(Check One)

U.S. Tax Code

Is the owner considered foreign under US Tax Code?

(Check One)

What is the purpose of this QCD?

Please provide the purpose of this QCD and include any additional information or comments here.