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Property Address
Primary Owner
Full Name
DOB
Second Owner
Full Name
DOB
Third Owner
Full Name
DOB
Previous Address
Have you lived at this address at least 6 months
What year was the home Built
When purchased(month)
(Year)
Brick or Frame
Square Footage
Garage?
Style(Circle):
Ranch
Bungalow
Cottage
1 Story
2 Story
Split Foyer
Tri Level
By Level
Others
Basement:
yes
No
Finished:
yes
No
How many Bathrooms
How many kitchens
How many Fireplaces
How many Bedrooms
Fire Hydrant(Within 300 meter or more)
Spice kitchen
yes
No
Cannabis Grown:
yes
No
Mortgages:
yes
No
1 Mortgages:
yes
No
Fire hall km Away
First time bought a House in Canada (Year)
Months
How long you have home or tenant insurance policy in Canada
Is there central heat:
yes
No
Gas heat or Electric:
yes
No
Is there a wood burning stove:
yes
No
Is there a space heater:
yes
No
Alarm System:
yes
No
|
if yes, Which Company
Alarm Company Name
How many people living on rent
How old is the roof
Shingles or Metal
How old is the AC/Heater
any electric updates
Plumbing Updates
Do you have animal's
What kind of animal
Breed of Dog
Is there a pool
is it fenced in
Is it above ground
Is there a trampoline
Are any appliances or work vehicles outside
Number of families
Do you live in the home or rent to others
Rental Value:
Is the home currently vacant
Is there sum-pump
Alarm in sum-pump
Yes
No
?
Is there water backup:
Back Flow Valve?
Flapper Or Gate
Any business operated in house:
Yes
No
Out Origin 
