APPLICATION FOR REAL ESTATE BOND
JD-CR-109 Rev. 11-08 C.G.S. § 54-66. Pr. Bk. Secs. 38-9, 43-2
STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov
Judicial District Geographic Area
State of Connecticut vs.
I, the undersigned, having been first duly sworn, make answer to the following questions:
Address of Real Estate Being Pledged (Number, street, town, state and zip code)
1. Has a notice of lien containing the terms of the bond been properly filed, pursuant to C.G.S. §54-66, on a form prescribed by the Office of the Chief Court Administrator with the town clerk of the town in which the property is located? No Yes (Attach proof of such filing) 2. Have you obtained an independent appraisal by a licensed real estate appraiser prepared within ninety (90) days of this application as to the present fair market value of the property? No Yes (Attach appraisal) Appraiser's statement of present fair market value: $ 3. Have you obtained from an attorney a current certificate of title containing a list of all encumbrances of record, including the notice of lien in question 1? No Yes (Attach the certificate of title) 4. Are there any encumbrances of record which were filed prior to the notice of lien required in question 1? (If yes, list each encumbrance and the amount thereof) Encumbrance No Yes Amount
5. Does any other person have any interest in this property?
Yes (If yes, list all owners)
6. What is your ownership interest in this property?
7. Are there any present tax liabilities?
No 8. Do you know of any other encumbrances or assessments? (If yes, list each encumbrance or assessment and the amount) Encumbrance/Assessment No Yes
Yes (If yes, in what amount?)
9. Is the property mortgaged?
Amount of Mortgage
Yes (If yes, to whom?) No Yes
What Is Your Equity In The Property?
10. Is this property pledged as security for any other bonds or for any other purpose? (If yes, list each pledge and the amount thereof) Pledge
11. Is there now any attachment, or suit in law or equity, pending, tending to affect your title?
Yes (If yes, describe below)
STATE OF CONNECTICUT COUNTY OF
Personally appeared to the truth thereof.
who subscribed to the foregoing application and made oath
INSTRUCTIONS TO AFFIANT: A separate affidavit must be signed by each owner of the property being pledged.