SJL, Inc. :: Consulting Engineers & Surveyors

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	Shaffer Pomeroy, Ltd.

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Location Survey Request Form

Date Ordered:
Date for Completion:
Ordered By (Name):
Company:
Address:
Address 2:
City:
State:
Zip/Postal Code:
Phone:
Fax:
eMail:
Property Address:
Property Address 2:
Present Owner:
New Owner:

Certify To:
Bank:
Title Insurance Company:
Title Company Job Number:

Legal Description:
Lot Number:
Subdivision:
Vol./Page:
City:
County:
Township:
Section:

	Send deed/legal description and covenants and restrictions to: eMail: sjl@sjl-inc.com Fax: 330-345-6725 Mail: SJL, Inc. 3477 Commerce Pkwy, Suite C Wooster, OH 44691